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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
( )
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
()
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
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
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)
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
NCCN Guideline
(strongly consider)
50
51
2030
(boost)
50(resection margin)
( )
()
baby oil
52
53
(
)
( )
(aqueous cream)
RadiaGel()
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
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
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.
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
(,lymphoedema)
82
83
()
1.
2.
()
3.
4.
()
( )
84
85
HER2
86
87
Zometa (zoledronic
Zometa
acid)
20%15
ibandronic
acid
Ibandronic acid (Bondronat)
D(
500 mg 400 IUs D;
D)
88
89
()
(X)
90
91
?
:
15%
10%
BRCA1BRCA2
50%(
)
45-87%70
27-50%
BRCA117
12.4%
BRCA
BRCA
BRCA
(Tamoxifen)
()
92
93
0
3
45
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
2010 10