乳腺癌临床实践指南.doc

此文档收集于网络，如有侵权，请联系网站删除乳腺癌临床实践指南(中国版)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乳腺癌专家组成员 *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 肿瘤内科 肿瘤放射科 血液科/肿瘤科 骨髓移植 肿瘤外科 患者支持 病理科 * 编委会成员 NCCN特别鸣谢 NCCN指南中国版专家组召集人：孙燕 中国医学科学院协和医科大学肿瘤医院 NCCN代表：Robert W. Carlson, MD Stanford Hospital and Clinics NCCN乳腺癌临床实践指南（中国版）讨论组 组长： 沈镇宙 复旦大学附属肿瘤医院 秘书： 江泽飞（兼） 中国人民解放军第三七医院 于世英（兼） 华中科技大学同济医学院附属同济医院 成员（按拼音顺序）： 郝希山 天津医科大学附属肿瘤医院 江泽飞 中国人民解放军第三七医院 李维廉 天津市人民医院 刘冬耕 中山大学附属肿瘤医院 罗荣城 南方医科大学附属南方医院 任军 北京大学临床肿瘤学院、北京肿瘤医院 沈坤炜 复旦大学附属肿瘤医院 徐兵河 中国医学科学院协和医科大学肿瘤医院 于世英 华中科技大学同济医学院附属同济医院 张保宁 中国医学科学院协和医科大学肿瘤医院 （本版仅公布参加本次NCCN乳腺癌临床实践指南（中国版）制订会议的专家。NCCN指南中国版顾问组及乳腺癌专家组正在确认中，将在指南下次更新时公布。） 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 录 NCCN乳腺癌专家组成员 NCCN特别鸣谢 非浸润性乳腺癌： 小叶原位癌(LCIS-1) 导管原位癌(DCIS-1) 浸润性乳腺癌： 临床分期和检查(BINV-1) 临床分期为I 、IIA或IIB期或T3,N1,M0乳腺癌的局部治疗(BINV-2) 全身辅助治疗(BINV-4) 术前化疗指南 l 临床分期为IIA、IIB期的检查(BINV-10) l 主要治疗和辅助治疗(BINV-11) l 临床分期为IIIA、IIIB期、IIIC期和IV期的检查(BINV-13) l 术前化疗、局部治疗和辅助治疗(BINV-14) 监测/随访、复发的检查或期乳腺癌的初次检查(BINV-15) 复发或期乳腺癌的治疗(BINV-16) 复发或期乳腺癌内分泌治疗的后续治疗(BINV-17) 外科腋窝分期I、IIA和IIB期乳腺癌(BINV-A) 腋窝淋巴结清扫(BINV-B) 浸润性乳腺癌切缘状况(BINV-C) 需要放疗的保乳治疗的禁忌证(BINV-D) 辅助内分泌治疗(BINV-E) 常用的术后辅助化疗方案(BINV-F) 绝经的定义(BINV-G) 二线内分泌治疗(BINV-H) 复发或转移性乳腺癌首选化疗方案(BINV-I) 肿瘤分期文稿参考文献 临床试验：NCCN认为任何肿瘤患者都可以在临床试验中得到最佳处理，因此特别鼓励肿瘤患者参加临床试验研究。 NCCN共识类别：除非特别说明，NCCN对所有推荐意见均达 成2A类共识。见NCCN共识分类。 本指南作为一项共识声明，反映了作者们对当前被认可的治疗方法的观点。任何临床医师欲参考或应用本指南，应根据个人所在的临床环境做出独立的医疗判断，以决 定患者需要的护理和治疗。NCCN对该指南的内容、应用不做任何提议或担保，并且不为此承担任何责任。本指南的版权为NCCN所有，并保留其他所有相关权利。没有 NCCN的书面允许，本指南和图解不能以任何方式被复制。 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 . 小叶原位 诊断检查 主要治疗减危措施 监测/随访 考虑用他莫昔芬治疗降低 风险(1类，见NCCN乳腺癌 每612个月询问1次病史并进行体格 检查 小叶原位癌 病史和体检 降低风险指南) 0期 双侧乳腺钼靶X线摄片 如果未进行双乳切除术，每12个月进 观察 或 行1次乳腺钼靶X线摄片 Tis，N0，M0 复习病理1 在特殊情况下，考虑双侧 如果应用他莫昔芬治疗，则根据 全乳切除乳房重建以降 NCCN乳腺癌降低风险指南进行监测 低风险 1 基于小叶原位癌的化疗措施与浸润性癌有很多的区别，建议请病理专家慎重做出病理诊断。 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 肿瘤学临床实践指南(中国版) 导管原位 2006年 第一版 诊断 检查 主要治疗 保乳手术1, ，不进行腋窝淋巴结清扫9， 2 +放疗3,4,5,6,7,8，或 全乳切除，不进行腋窝淋巴结清扫4,6,9， 乳房重建 病史和体检 见术后治疗 导管原位癌 0期 双侧乳腺钼靶X线摄片 （DCIS-2） 复习病理 保乳手术1,2,9+放疗3,4,5,6,7,8，或 Tis，N0，M0 6, 9 确定肿瘤雌激素受体状态 小病灶(0.5 cm) 全乳切除，不进行腋窝淋巴结清扫4, 单一病灶，低级别 乳房重建，或 仅行保乳手术(2B类)1,2,5,6,7,8,9 1 愿行保乳治疗的患者，为获得阴性切缘可行再次切除。保乳手术不能做到切缘阴性时应行全乳切除。 2 见导管原位癌切缘状况(DCIS-A)。 3 全乳放疗伴肿瘤床加强照射 (采用光子、近距离放疗或电子束)。对50岁的患者，尤其鼓励肿瘤床加强照射。局部乳腺放疗只有在高质量的前瞻性临床试验中才可实行。 4 全乳切除与病灶切除加放疗的远期生存情况相当。 5 完全切除应当由切缘分析、切除标本的钼靶摄片和切除后原病灶部位的钼靶摄片的结果加入证实。 6 在全乳切除或肿瘤再切除时发现有浸润性病变的患者，应作为I期或II期病变管理(包括淋巴结分期)。