乳腺癌臨床實(shí)踐指南.doc

此文檔收集于網(wǎng)絡(luò)，如有侵權(quán)，請(qǐng)聯(lián)系網(wǎng)站刪除乳腺癌臨床實(shí)踐指南(中國(guó)版)2006年 第一版Copyright National Comprehensive Cancer Network 2006. All rights reserved. “NCCN”, the NCCN logo, and “National Comprehensive Cancer Network” are registered trademarks of the National Comprehensive Cancer Network. The Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Breast Cancer Guideline 2006 is the Chinese adapted version of NCCN Clinical Practice Guidelines in Oncology-Breast Cancer Guideline, V.2.2006 as permitted and endorsed by NCCN. It is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. The original guideline and Chinese edition are both available at: . To view the most recent and complete version of the guideline, go online to . These Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. These Guidelines are a work in progress that will be refined as often as new significant data becomes available. The NCCN Guidelines are a statement of consensus of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN guideline is expected to use independent medical judgment in the context of individual clinical circumstance to determine any patients care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. This publication should not be used for commercial purpose. It is provided for free to Chinese medical professions with the support of the unrestrictive educational grant of Bristol-Myers Squibb Co. Ltd. which exerts no influence to the formation of The Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Breast Cancer Guideline 2006. NCCN乳腺癌專家組成員 *Robert W. Carlson, MD/Chair Stanford Hospital and Clinics Daniel F. Hayes, MDUniversity of Michigan Comprehensive Cancer Center Elizabeth C. Reed, MD UNMC Eppley Cancer Center at The Nebraska Medical Center Benjamin O. Anderson, MD Fred Hutchinson Cancer Research Clifford Hudis, MD Samuel M. Silver, MD, PhD Center/Seattle Cancer Care Alliance Memorial Sloan-Kettering Cancer Center University of Michigan Comprehensive Cancer Center Harold J. Burstein, MD, PhD Mohammad Jahanzeb, MD Dana-Farber/Partners CancerCare Mary Lou Smith, JD, MBA St. Jude Childrens Research Hospital/ Consultant University of Tennessee Cancer Institute W. Bradford Carter, MD H. Lee Moffitt Cancer Center & Research George Somlo, MD Britt-Marie Ljung, MD Institute at the University of South Florida City of Hope Cancer Center UCSF Comprehensive Cancer Center *Richard Theriault, DO, MBA *Stephen B. Edge, MD The University of Texas M. D. Anderson Roswell Park Cancer Institute Lawrence B. Marks, MD Duke Comprehensive Cancer Center Cancer Center William B. Farrar, MD John H. Ward, MD Arthur G. James Cancer Hospital & Richard *Beryl McCormick, MD Huntsman Cancer Institute at the J. Solove Research Institute at The Ohio Memorial Sloan-Kettering Cancer Center University of Utah State University Lisle M. Nabell, MD Eric P. Winer, MD Lori J. Goldstein, MD University of Alabama at Birmingham Dana-Farber/Partners CancerCare Fox Chase Cancer Center Comprehensive Cancer Center Antonio C. Wolff, MD William J. Gradishar, MD Lori J. Pierce, MD The Sidney Kimmel Comprehensive Robert H. Lurie Comprehensive Cancer University of Michigan Comprehensive Cancer Center at Johns Hopkins Center of Northwestern University Cancer Center University 腫瘤內(nèi)科 腫瘤放射科 血液科/腫瘤科 骨髓移植 腫瘤外科 患者支持 病理科 * 編委會(huì)成員 NCCN特別鳴謝 NCCN指南中國(guó)版專家組召集人：孫燕 中國(guó)醫(yī)學(xué)科學(xué)院協(xié)和醫(yī)科大學(xué)腫瘤醫(yī)院 NCCN代表：Robert W. Carlson, MD Stanford Hospital and Clinics NCCN乳腺癌臨床實(shí)踐指南（中國(guó)版）討論組 組長(zhǎng)： 沈鎮(zhèn)宙 復(fù)旦大學(xué)附屬腫瘤醫(yī)院 秘書(shū)： 江澤飛（兼） 中國(guó)人民解放軍第三七醫(yī)院 于世英（兼） 華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院 成員（按拼音順序）： 郝希山 天津醫(yī)科大學(xué)附屬腫瘤醫(yī)院 江澤飛 中國(guó)人民解放軍第三七醫(yī)院 李維廉 天津市人民醫(yī)院 劉冬耕 中山大學(xué)附屬腫瘤醫(yī)院 羅榮城 南方醫(yī)科大學(xué)附屬南方醫(yī)院 任軍 北京大學(xué)臨床腫瘤學(xué)院、北京腫瘤醫(yī)院 沈坤煒 復(fù)旦大學(xué)附屬腫瘤醫(yī)院 徐兵河 中國(guó)醫(yī)學(xué)科學(xué)院協(xié)和醫(yī)科大學(xué)腫瘤醫(yī)院 于世英 華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院 張保寧 中國(guó)醫(yī)學(xué)科學(xué)院協(xié)和醫(yī)科大學(xué)腫瘤醫(yī)院 （本版僅公布參加本次NCCN乳腺癌臨床實(shí)踐指南（中國(guó)版）制訂會(huì)議的專家。NCCN指南中國(guó)版顧問(wèn)組及乳腺癌專家組正在確認(rèn)中，將在指南下次更新時(shí)公布。） National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. The Chinese edition 2006 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive Cancer Network. To view the most recent and complete version of this or any other guideline, visit . 目 錄 NCCN乳腺癌專家組成員 NCCN特別鳴謝 非浸潤(rùn)性乳腺癌： 小葉原位癌(LCIS-1) 導(dǎo)管原位癌(DCIS-1) 浸潤(rùn)性乳腺癌： 臨床分期和檢查(BINV-1) 臨床分期為I 、IIA或IIB期或T3,N1,M0乳腺癌的局部治療(BINV-2) 全身輔助治療(BINV-4) 術(shù)前化療指南 l 臨床分期為IIA、IIB期的檢查(BINV-10) l 主要治療和輔助治療(BINV-11) l 臨床分期為IIIA、IIIB期、IIIC期和IV期的檢查(BINV-13) l 術(shù)前化療、局部治療和輔助治療(BINV-14) 監(jiān)測(cè)/隨訪、復(fù)發(fā)的檢查或期乳腺癌的初次檢查(BINV-15) 復(fù)發(fā)或期乳腺癌的治療(BINV-16) 復(fù)發(fā)或期乳腺癌內(nèi)分泌治療的后續(xù)治療(BINV-17) 外科腋窩分期I、IIA和IIB期乳腺癌(BINV-A) 腋窩淋巴結(jié)清掃(BINV-B) 浸潤(rùn)性乳腺癌切緣狀況(BINV-C) 需要放療的保乳治療的禁忌證(BINV-D) 輔助內(nèi)分泌治療(BINV-E) 常用的術(shù)后輔助化療方案(BINV-F) 絕經(jīng)的定義(BINV-G) 二線內(nèi)分泌治療(BINV-H) 復(fù)發(fā)或轉(zhuǎn)移性乳腺癌首選化療方案(BINV-I) 腫瘤分期文稿參考文獻(xiàn) 臨床試驗(yàn)：NCCN認(rèn)為任何腫瘤患者都可以在臨床試驗(yàn)中得到最佳處理，因此特別鼓勵(lì)腫瘤患者參加臨床試驗(yàn)研究。 NCCN共識(shí)類別：除非特別說(shuō)明，NCCN對(duì)所有推薦意見(jiàn)均達(dá) 成2A類共識(shí)。見(jiàn)NCCN共識(shí)分類。 本指南作為一項(xiàng)共識(shí)聲明，反映了作者們對(duì)當(dāng)前被認(rèn)可的治療方法的觀點(diǎn)。任何臨床醫(yī)師欲參考或應(yīng)用本指南，應(yīng)根據(jù)個(gè)人所在的臨床環(huán)境做出獨(dú)立的醫(yī)療判斷，以決 定患者需要的護(hù)理和治療。NCCN對(duì)該指南的內(nèi)容、應(yīng)用不做任何提議或擔(dān)保，并且不為此承擔(dān)任何責(zé)任。本指南的版權(quán)為NCCN所有，并保留其他所有相關(guān)權(quán)利。沒(méi)有 NCCN的書(shū)面允許，本指南和圖解不能以任何方式被復(fù)制。 2006 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. The Chinese edition 2006 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive Cancer Network. To view the most recent and complete version of this or any other guideline, visit . 小葉原位 診斷檢查 主要治療減危措施 監(jiān)測(cè)/隨訪 考慮用他莫昔芬治療降低 風(fēng)險(xiǎn)(1類，見(jiàn)NCCN乳腺癌 每612個(gè)月詢問(wèn)1次病史并進(jìn)行體格 檢查 小葉原位癌 病史和體檢 降低風(fēng)險(xiǎn)指南) 0期 雙側(cè)乳腺鉬靶X線攝片 如果未進(jìn)行雙乳切除術(shù)，每12個(gè)月進(jìn) 觀察 或 行1次乳腺鉬靶X線攝片 Tis，N0，M0 復(fù)習(xí)病理1 在特殊情況下，考慮雙側(cè) 如果應(yīng)用他莫昔芬治療，則根據(jù) 全乳切除乳房重建以降 NCCN乳腺癌降低風(fēng)險(xiǎn)指南進(jìn)行監(jiān)測(cè) 低風(fēng)險(xiǎn) 1 基于小葉原位癌的化療措施與浸潤(rùn)性癌有很多的區(qū)別，建議請(qǐng)病理專家慎重做出病理診斷。 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. LCIS-1 The Chinese edition 2006 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive Cancer Network. To view the most recent and complete version of this or any other guideline, visit . NCCN 腫瘤學(xué)臨床實(shí)踐指南(中國(guó)版) 導(dǎo)管原位 2006年 第一版 診斷 檢查 主要治療 保乳手術(shù)1, ，不進(jìn)行腋窩淋巴結(jié)清掃9， 2 +放療3,4,5,6,7,8，或 全乳切除，不進(jìn)行腋窩淋巴結(jié)清掃4,6,9， 乳房重建 病史和體檢 見(jiàn)術(shù)后治療 導(dǎo)管原位癌 0期 雙側(cè)乳腺鉬靶X線攝片 （DCIS-2） 復(fù)習(xí)病理 保乳手術(shù)1,2,9+放療3,4,5,6,7,8，或 Tis，N0，M0 6, 9 確定腫瘤雌激素受體狀態(tài) 小病灶(0.5 cm) 全乳切除，不進(jìn)行腋窩淋巴結(jié)清掃4, 單一病灶，低級(jí)別 乳房重建，或 僅行保乳手術(shù)(2B類)1,2,5,6,7,8,9 1 愿行保乳治療的患者，為獲得陰性切緣可行再次切除。保乳手術(shù)不能做到切緣陰性時(shí)應(yīng)行全乳切除。 2 見(jiàn)導(dǎo)管原位癌切緣狀況(DCIS-A)。 3 全乳放療伴腫瘤床加強(qiáng)照射 (采用光子、近距離放療或電子束)。對(duì)50歲的患者，尤其鼓勵(lì)腫瘤床加強(qiáng)照射。局部乳腺放療只有在高質(zhì)量的前瞻性臨床試驗(yàn)中才可實(shí)行。 4 全乳切除與病灶切除加放療的遠(yuǎn)期生存情況相當(dāng)。 5 完全切除應(yīng)當(dāng)由切緣分析、切除標(biāo)本的鉬靶攝片和切除后原病灶部位的鉬靶攝片的結(jié)果加入證實(shí)。 6 在全乳切除或腫瘤再切除時(shí)發(fā)現(xiàn)有浸潤(rùn)性病變的患者，應(yīng)作為I期或II期病變管理(包括淋巴結(jié)分期)。