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H E R2

1986
1995

2- 3

6- 15

16- 19

20- 39

40- 49

50- 55

56- 59

HER 2

60- 67

68- 71

72- 85

86- 91

92- 95

96- 97

98- 99

(http://www.ha.org.hk/pyneh/onc/cbrinfo.html)


G oogle

(CAbreast@gmail.com)

am )
gr
mo
am
(M

X
(U lt ra so un d)

)
(M RI

X(Mammogram)
()
(Ultrasound)X

XX
X

(MRI)
1

(false
positives)
(Emerging data indicate that MRI does not reduce
re-excision rates and that it causes false positives
in terms of detection and unnecessary surgery;
overall there is little high-quality evidence at
present to support the routine use of preoperative
MRI.) 20102(COMICE) 2

(MRI)
MRI
1. Houssami N, Hayes D. Review of Preoperative Magnetic Resonance Imaging (MRI) in Breast Cancer - Should MRI Be Performed on All
Women with Newly Diagnosed, Early Stage Breast Cancer? CA A Cancer Journal for Clinicians, Volume 59, Issue 5 (p 290-302).
2. Turnbull L, Brown S, Harvey I, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomized controlled trial.
Lancet 2010;375 (9714):563-71.

(
)(bone scan)
(Ultrasound liver scan)(CT scan)
(PET scan)


:
(Breast Conservation Treatment)

1-2

2-3cm

(connective tissue disease)



( )

20%

3 502cm
39%46%
1. Yau TK, Soong IS, Chan K, et al. Clinical outcome of breast conservation therapy for breast cancer in Hong Kong: prognostic impact of
ipsilateral breast tumour recurrence and 2005 St Gallen risk categories. Int J Radiat Oncol Biol Phys. 2007;68:667-672.
2. Yau TK, Lau Y, Kong J, et al. Breast conservation treatment in Hong Kong - early results of 203 patients: retrospective study. Hong Kong
Med J. 2002;8:322-328.
3. Yau TK, Soong IS, Sze H, et al. Trends and patterns of breast conservation treatment in Hong Kong: 1994-2007. Int J Radiat Oncol Biol
Phys. 2009;74:98-103.

(resection margin)

Cancer

1 2mm

(sentinel lymph node biopsy)

()

10%

Ca nc er

1. Yau TK, Soong IS, Chan K, et al. Clinical outcome of breast conservation therapy for breast cancer in Hong Kong: prognostic impact of
ipsilateral breast tumour recurrence and 2005 St Gallen risk categories. Int J Radiat Oncol Biol Phys. 2007;68:667-672.

10

11

35-40

3%

(90)

(X)
701cm1cm

1,000

1. Yau TK, Choi CW, Sze H, et al. Should young age be a contra-indication to breast conservation treatment in Chinese women? Twelve-year
experience from a public cancer centre in Hong Kong. Hong Kong Med J. 2009;15:94-99

12

13

78

(TRAM Flap

Breast Reconstruction)


1. Soong IS, Yau TK, Ho CM, et al. Post-mastectomy radiotherapy after immediate autologous breast reconstruction in primary treatment of
breast cancers. Clin Oncol. 2004;16:283-289.

14

15

)
an
sc
ET
(P

:
(PET scan)

( A)


(B) ( C)

16

17

?
?

(T,tumour)(N,node)
(M,metastasis)

Oncotype DX

(hormonal receptors)
(histological grading) HER2

ing)
(h istol ogic al grad
()

St Gallen Consensus

(Tamoxifen)
St Ga llen

St Ga llen

13%()

18

19

:
Chemotherapy
(Chemical drug)

(cycle)


Dox oru bici n(

Adriamycin
)

Cyclophosphamide(
)

A C

Docetaxel(

Tax
ote re) Pac litax el(

) T
AC AC- P

20

21

()

Cyclophosphamide(Endoxan)

Capecitabine(Xeloda,)Vinorelbine(Navelbine)

()

Cyclophosphamide

Cyclophosphamide
(MethotrexateFluorouracil)CMF

ham ide
C ycl oph osp

22

23

St Gallen Consensus

(There is no agreement about the definition of a standard


chemotherapy regimen for any disease subset)

HER2
TAC

A
C-D (Do cet axe l)

TAC

24

25

0
3

(Tamoxifen)

Adriamycin () Herceptin()

35

40

20

26

27

20%

(growth factors)

(dose dense)

Neupogen
24

Neulastim
11,000!

1
TC(Taxotere-Cyclophosphamide)21%
5%

1. Yau TK, Ng TY, Soong S, et al. Toxicity of Docetaxel plus Cyclophosphamide (TC) as adjuvant therapy for breast cancer in Chinese
patientsthe Hong Kong experience. Asia-Pacific J of Clin Oncol. 2009;5:123-128.

28

29

(growth factors)

(TAC)(dose-dense

(Neutrophil)
Arginine()

Glutamine()Omega3

(Absolute Neutrophil Count, ANC)

1.5 (x 10 9 /L)

(Immunonutrition)

(100 x 10 9 /L)

(Ne

utr op hil)

(T he

n
io
etic Associat
American Diet

AD A)

1. Mok TS, Yeo W, Johnson PJ, et al. A double-blind placebo-controlled


randomized study of Chinese herbal medicine as complementary
therapy for reduction of chemotherapy-induced toxicity. Ann Oncol
2007;18:768-774.

30

31

%
33

?
5%

:
10%(Hepatitis B carrier)
()

:
AB100
A15(85)B

Lamivudine(

10(90)

Zeffix)Entecavir(Baraclude)

1510

(33%)9085

EntecavirLamivudine

5%

5-8%

32

33

()

3.

PortPortacath
port()
Port

1.
(Hickman Catheter)

Port

2. PICC

(Portacath)

()
(Hickman)(PICC)

()

34

35

36

37

35

38

39

ER(Estrogen Receptor)PR(Progesterone
Receptor)(negative)
(positive)
(ERPR)

40

41

3. (GnRH analogues)

(Hormonal therapy)

Zoladex

(hormone)(hormone antagonist)

4. Faslodex

1. (Tamoxifen)

Faslodex

2. (Aromastase Inhibitor)
FemaraAromasinArimidex

42

43

)
n
e
f
i
x
o
m
a
T
(

(Tamoxifen)

()

44

45

48

n
fe
xi
mo
Ta
?

Ta mo xi fe n

(Tamoxifen)

(AI)

(Aromastase Inhibitor

AI)Femara
Aromasin Arimidex

(Tamoxifen)

1,000

2-3%

)
(

46

47

ox if en )
am
(T

2009

(Tamoxifen)

()

()

SSRI
(Selective Serotonin Reuptake Inhibitors)
SNRI(Serotonin-Norepinephrine Reuptake
I n h i b i t o r s )
Fluoxetine(Arozac)Paroxetine(Seroxat)
Sertraline(Serloft)

SSRI/SNRI(Fluoxetine
ParoxetineSertralineBupropion
Duloxetine)

CYP2D6
SSRI/SNRI

(AI)

(
)
(extended hormonal therapy)

Femara

SSRI/SNRI(
CelexaLexaproLuvox)

(Perphenazine
ThiothixenePimozide)

SSRI/SNRISSRI
Effexor(venlafaxine)

48

49

?
?

:
(Radiotherapy,RT)
X

(breast conservation treatment)


25%10%
(mastectomy)
(resection margin)
25-35% 10%
?

NCCN Guideline
(strongly consider)

50

51

2030

(boost)

50(resection margin)

( )

(partial breast irradiation)

()
baby oil

52

53

(
)
( )

(aqueous cream)

RadiaGel()

(1% hydrocortisone cream)

95%

(
)

54

55

(ductal
carcinoma in-situDCIS)

1%

(invasive)

(Breast screening)

10-15%

56

57

1%

()

()

(positive)

(Tamoxifen)

75

(Tamoxifen)

()

1%

1. Yau TK, Chan K, Chan M, et al. Wide Local Excision and Radiotherapy for the Treatment of Ductal Carcinoma in situ of the Breast: the
Hong Kong Experience. Clin Oncol 2006;18:447-452

58

59

HER2

HER2

HER2
HER2Human Epidermal growth factor
Receptor 2
HER2HER2
(HER2)

25%HER2
HER2

HER2
HER2
HER2

HER2

60

61

R2
HE

HER2

HER2HER2

HerceptinHER2

(HER2 overexpression)

HER2

8-10%

(1cm)

(immunohistochemistry,

IHC)IHCHER2

HER2

0,1,2,33HER2
2
F I S H

I HC
H ER2

(fluorescence in-situ hybridization


)2FISH
HER2
1
2008

HER2

20

1. Yau TK, Sze H, Soong IS, et al. HER2 overexpression of breast cancers in Hong Kong: prevalence and concordance between immunohistochemistry and in-situ hybridization assays. Hong Kong Med J. 2008;14:130-135.

HER2

62

63

n
i
t
p
e
c
r
e
H

2
R
E
H

HER2

:
Herceptin(Trastuzumab)HER2
(monoclonal antibody)

HER2

HER2Tykerb

(Lapatinib)HER2

HerceptinTykerb
Xeloda(aromastase inhibitor)

HER2

TykerbHerceptin

HE R2 H erceptin

Tyk erb

Hercept in HER2

HER2

64

65

HER2
)
He rc ep ti n(
He rc ep ti n

2
R
E
H

HerceptinTykerbHER275%HER2

:
Herceptin
Herceptin
HER2TykerbHerceptin
Xeloda

HER2Bevacizumab(Avastin
)
12-14%

(FDA)BevacizumabHER2

HER2
Bevacizumab

HER2

66

67

:
(triple-negative
breast cancer, TNBC)
(ER)(PR)
HER2(negative)

(DNA microarray)

(subtype)
(basal-like)

10-15%(BRCA1)
X

68

69

:
HER2
()

Bevacizumab()

PARP
(PARP inhibitors)PARPDNA
PARP
PARP
PARP
PARP(BRCA)

(http://w

ww.tnbc foundati on.org/)

70

71

72

73

()

1.

1.

2.

230g5 500g
(1)

(2) 1.5

2.
250g2515g
500g
(1)

(2) 1.5

3.
115g2250g250g

3.

(1)

(2)
(3) 2

74

75

4.

7.

50g50g1500g3

30g15g250ml

(1)

(1)
(2)

(2) 10 3
5
(3) 1.5

8.
30g15g250ml
(1)

5.

(2)

250g3

(1)

(2) 1

9.

6.
30g15500g

10. /

(1)

(2) 1.5

76

77

1.

X(mammogram)

30g

84

2.

(American Society of Clinical Oncology,


ASCO)(CA15.3)

30g

84

X
(mammogram)511 1

3.
250g3
(1)

4.5%40%X

(2) 1

4.
50g 1500g3
(1)
(2) 2

1. Yau TK, Sze H, Soong IS, et al. Surveillance mammography after breast conservation therapy in Hong Kong: effectiveness and feasibility
of risk-adapted approach. The Breast 2008; 17:132-137

78

79

1.

12

2.
1

21

3.
2

4.

12

80

81

(isoflavone)
(phytoestrogens)

Tamoxifen

(lymphatic system)(lymph node)


(lymph vessels)

(,lymphoedema)

82

83

()
1.

2.

()
3.

4.

()
( )

84

85

HER2

86

87

Zometa (zoledronic

Zometa

acid)

20%15

Bonviva (ibandronic acid)

ibandronic
acid
Ibandronic acid (Bondronat)

D(
500 mg 400 IUs D;

D)

(osteonecrosis of jaw, ONJ)

88

89

()

not curable but treatable()

(X)

90

91

?
:

15%
10%
BRCA1BRCA2
50%(
)

45-87%70
27-50%

BRCA117

12.4%
BRCA
BRCA
BRCA

(Tamoxifen)
()

92

93

0
3

(Hong Hong Hereditary and High

45

Risk Breast Cancer Programme, HRBCP)BRCA

BRCA

(2835 8877)

2589 8151

BRCA()

(www.HRBCP.org; www.asiabreastregistry.com)

BRCA

94

95

http://www.ha.org.hk/pyneh/onc/cbrinfo.html

(CA 15.3)

?

? ?

(aspirin)

96

97

()

()

()

()

()

()

()

()

()

()

()

()



1986
1995

:
: (852) 3921 3821
: (852) 3921 3822
: admin @hkacs .o rg .hk
: w w w .hkacs .o rg .hk


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