Gerber Bernd, Freund Mathias, Reimer Toralf
Universitätsfrauenklinik am Klinikum Südstadt der Hansestadt Rostock, Germany.
Dtsch Arztebl Int. 2010 Feb;107(6):85-91. doi: 10.3238/arztebl.2010.0085. Epub 2010 Feb 12.
Recurrent breast cancer remains a challenge for interdisciplinary treatment even though new therapeutic options are available.
The PubMed database was selectively searched for articles that appeared from 1999 to 2009 and contained the key words "breast cancer," "recurrence," "metastatic," "advanced," and "treatment". Further sources consulted for this review included the German S3 guideline, the treatment recommendations of the German AGO-Mamma group, the NCCN guidelines, and the Cochrane database.
Locoregional recurrences are treated with curative intent. Metastatic breast cancer must be treated on an individualized basis: The treatment should be continued as long as its benefits for the individual patient outweigh its adverse side effects. Endocrine treatment is indicated for all patients whose tumors are hormone-receptor positive or of unknown receptor status and who have enough time for a response to be seen. Chemotherapy should be given if the tumor is hormone-receptor negative, if a rapid response is urgently needed, or if endocrine treatment has failed to produce a response. Combination chemotherapy improves response rates and prolongs progression-free survival, yet it does not prolong overall survival in comparison to monochemotherapy. In HER2-positive patients, first-line treatment with trastuzumab and monochemotherapy prolongs overall survival. Other treatment options include angiogenesis inhibitors, various tyrosine kinases inhibitors, radiotherapy, bisphosphonates, surgical or other ablative treatment of metastases, or a combination of these approaches, applied either simultaneously or consecutively.
While locoregional recurrences of breast cancer should be treated with curative intent, breast cancer with distant metastases is currently not curable. It is treated with the intention of restoring and maintaining good quality of life and relieving symptoms due to the metastases, rather than prolonging survival.
尽管有了新的治疗选择，但复发性乳腺癌的多学科治疗仍是一项挑战。
在PubMed数据库中进行选择性检索，查找1999年至2009年发表的包含关键词“乳腺癌”“复发”“转移”“晚期”和“治疗”的文章。本综述参考的其他资料来源包括德国S3指南、德国AGO-乳腺组的治疗建议、美国国立综合癌症网络（NCCN）指南和Cochrane数据库。
局部区域复发采用根治性治疗。转移性乳腺癌必须个体化治疗：只要对个体患者的益处超过其不良副作用，就应持续治疗。对于所有肿瘤激素受体阳性或受体状态未知且有足够时间观察到反应的患者，均应进行内分泌治疗。如果肿瘤激素受体阴性、急需快速反应或内分泌治疗未产生反应，则应给予化疗。联合化疗可提高缓解率并延长无进展生存期，但与单药化疗相比，并未延长总生存期。在人表皮生长因子受体2（HER2）阳性患者中，曲妥珠单抗一线治疗和单药化疗可延长总生存期。其他治疗选择包括血管生成抑制剂、各种酪氨酸激酶抑制剂、放疗、双膦酸盐、转移灶的手术或其他消融治疗，或这些方法的联合应用，可同时或相继使用。
虽然乳腺癌局部区域复发应采用根治性治疗，但伴有远处转移的乳腺癌目前无法治愈。其治疗目的是恢复和维持良好的生活质量并缓解转移引起的症状，而非延长生存期。
