Kurebayashi Junichi
Kawasaki Medical School, Department of Breast and Thyroid Surgery.
Clin Calcium. 2008 Apr;18(4):447-54.
Breast cancer most frequently causes bone metastases in solid tumors. It has been known that there is a vicious cycle consisting of tumor cells, osteoblasts, osteoclasts and various humoral factors in osteolytic lesions. Although systemic therapy is a main treatment of bone metastases, local therapies, such as radiotherapy and surgical therapy, are also promptly needed when bone-related complications occur. In recent years, anti-osteoclast agents, bisphosphonates significantly contribute to the delay of occurrence of bone-related complications. Postoperative adjuvant therapy significantly reduces the incidence of recurrence in breast cancer patients. Chemotherapy and LH-RH agonists cause ovarian function suppression in premenopausal patients, and aromatase inhibitors cause estrogen deprivation in postmenopausal patients. These effects cause unbalance of bone metabolism, loss of bone density and increase in the incidence of fractures. Improvement of these bone-related adverse effects and careful follow-ups are needed for breast cancer patients.
在实体瘤中,乳腺癌最常引起骨转移。众所周知,在溶骨性病变中,肿瘤细胞、成骨细胞、破骨细胞和各种体液因子构成了一个恶性循环。虽然全身治疗是骨转移的主要治疗方法,但当发生骨相关并发症时,也迫切需要局部治疗,如放疗和手术治疗。近年来,抗破骨细胞药物双膦酸盐对延缓骨相关并发症的发生有显著作用。术后辅助治疗可显著降低乳腺癌患者的复发率。化疗和促黄体生成素释放激素激动剂会导致绝经前患者卵巢功能抑制,芳香化酶抑制剂会导致绝经后患者雌激素缺乏。这些作用会导致骨代谢失衡、骨密度降低和骨折发生率增加。乳腺癌患者需要改善这些骨相关不良反应并进行仔细的随访。