Presented by William Gradishar, MD, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, and Kilian E. Salerno, MD, Roswell Park Cancer Institute, Buffalo, New York.
J Natl Compr Canc Netw. 2016 May;14(5 Suppl):641-4. doi: 10.6004/jnccn.2016.0181.
The updates to management of early invasive breast cancer in 2016 are minor but have important treatment implications for patients. The NCCN Guidelines Panel for Breast Cancer has added endocrine therapy to its recommendations for the neoadjuvant treatment of patients with ER-rich tumors. For women who are premenopausal at diagnosis, the NCCN Guidelines suggest tamoxifen for 5 years, with or without ovarian suppression, or an aromatase inhibitor for 5 years combined with ovarian suppression or ablation. For HER2-positive patients, neoadjuvant pertuzumab is acceptable, and in advanced estrogen receptor-positive disease, palbociclib can be given with endocrine therapy. Hypofractionation is now the preferred approach for whole-breast irradiation after breast-conserving therapy. Regional nodal irradiation should be strongly considered for women with 1 to 3 positive lymph nodes and is indicated for those with 4 or more positive nodes.
2016 年早期浸润性乳腺癌管理的更新内容很小，但对患者的治疗有重要意义。NCCN 乳腺癌指南专家组在 ER 阳性肿瘤患者的新辅助治疗建议中增加了内分泌治疗。对于诊断时处于绝经前的女性，NCCN 指南建议使用他莫昔芬治疗 5 年，可联合或不联合卵巢抑制，或使用芳香化酶抑制剂治疗 5 年，同时联合卵巢抑制或消融。对于 HER2 阳性患者，新辅助使用帕妥珠单抗是可以接受的，在晚期雌激素受体阳性疾病中，可以在内分泌治疗的基础上加用哌柏西利。对于保乳治疗后的全乳放疗，现在推荐采用适形调强放疗。对于 1 至 3 个阳性淋巴结的女性，强烈考虑进行区域淋巴结放疗，而对于 4 个或更多阳性淋巴结的女性，区域淋巴结放疗是指征。
