Szántó J
National Institute of Oncology, Budapest, Hungary.
Acta Med Hung. 1994;50(3-4):185-93.
The treatment of clinically overt metastatic breast cancer, despite several treatment modalities (biological response modifiers, megatherapy with autologous bone marrow transplantation, growth factors, new agents, etc.) is in a static phase. In the decision-making one has to consider the patient's age, her menstrual state, the metastatic site, previous adjuvant and/or postoperative treatment modalities. Roughly there are two treatment forms, the hormonal and the cytostatic ones. Endocrine therapy should be given as follows: 1. only for low risk group, 2. gestagen or antiestrogen therapy is the choice for the first step, 3. if there is a progression in 3 months, the hormonal treatment should be changed to cytostatic combination, 4. if there is a progression beyond 3 months further hormonal therapy can be considered. The efficacy of endocrine therapy is 30%. In patients with advanced breast cancer chemotherapy provides a response rate of 30 to 60%, however total survival of the patients does not improve substantially. Doxorubicin containing regimens are more effective, however no response in total survival can be obtained. New plant alkaloids and altered treatment forms will probably influence survival. Taking all these into consideration one has to decide on the quality of life of the breast cancer patients.
尽管有多种治疗方式（生物反应调节剂、自体骨髓移植大剂量疗法、生长因子、新型药物等），临床上明显的转移性乳腺癌的治疗仍处于停滞阶段。在决策时，必须考虑患者的年龄、月经状态、转移部位、先前的辅助和/或术后治疗方式。大致有两种治疗形式，即激素治疗和细胞毒性药物治疗。内分泌治疗应如下进行：1. 仅用于低风险组；2. 第一步选择孕激素或抗雌激素治疗；3. 如果在3个月内病情进展，应将激素治疗改为细胞毒性药物联合治疗；4. 如果在3个月后病情进展，可以考虑进一步的激素治疗。内分泌治疗的有效率为30%。在晚期乳腺癌患者中，化疗的缓解率为30%至60%，然而患者的总生存期并未显著改善。含阿霉素的方案更有效，但在总生存期方面并无改善。新型植物生物碱和改变的治疗形式可能会影响生存期。考虑到所有这些因素，必须对乳腺癌患者的生活质量做出决定。
