乳腺癌骨转移的诊治.ppt

乳腺癌骨转移和骨相关疾病的诊断和治疗,Diagnosisandtreatmentofbonemetastasisofbreastcancer,流行病学Epidemiology,骨转移的比例仅次于肺、肝脏的转移Theratioofbonemetastasisissecondarytolungandliver通常为多发，单发转移者仅占10%Usuallyformultiplebonemetastasis,only10%forsingle80%为中轴骨，如脊柱和骨盆80%foraxialskeleton,suchasthespineandpelvis,目录Catalogue,乳腺癌骨转移概述1.Overview二.乳腺癌骨转移诊断方法2.Diagnosticmethod三.乳腺癌骨转移临床表现3.Clinicalmanifestation四.乳腺癌骨转移治疗4.Treatment,概述Overview,骨转移是乳腺癌最常见的远处转移部位Bonemetastasisisthemostcommondistantmetastasesinbreastcancerpatients晚期乳腺癌骨转移发生率为65%75%Theincidenceofbonemetastasisinterminalbreastcanceris65%75%骨痛、骨相关事件（SREs）及生活质量降低是乳腺癌骨转移的常见并发症Bonepain,bonerelatedevents(SREs)andreducedqualityoflifearecommoncomplicationsofbonemetastasisofbreastcancer参考文献references1.ColemanRE.CancerTreatRev.2001Jun;27(3):165-76.2.JohnR.Johnson,GrantWilliams,etal.JClinOncol21:1404-1411.3.KinnaneN.EurJOncolNurs.2007;11Suppl2:S28-31.Epub2007Sep4.,诊断方法Diagnosis,骨转移初筛诊断方法：骨放射性核素扫描（ECT）Thepreliminaryscreeningmethodofbonemetastasis：ECT推荐用于出现骨疼痛、骨折、AKP升高、或高钙血症等可疑骨转移的常规初筛诊断检查Itisrecommendedtobeusedforpatientsofbonepain,fracture,AKPelevation,orhypercalcemia乳腺癌分期T3N1M0患者常规检查RoutineexaminationofpatientswithbreastcancerstageT3N1M0复发转移乳腺癌患者的常规检查Routineexaminationofpatientswithrecurrentmetastasis,骨转移的影像学确诊检查方法：骨X线/CT/MRIConfirmedRadiographicdiagnosisofbonemetastasis:X-ray/CT/MRI60%-78%溶骨性破坏、10%-20%成骨性、12%-20%混合性Osteolysis60%-78%,ossify10%-20%,mixed12%-20%骨活检：诊断乳腺癌骨转移的金标准Biopsy:Diagnosticcriteriaforbonemetastasisinbreastcancer,临床表现Clinicalmanifestation,症状：疼痛、病理性骨折、高钙血症、肢体功能障碍等Symptoms:pain,pathologicalfracture,hypercalcemia,andlimbdysfunction乳癌骨转移特点：早期一般无症状，晚期疼痛剧烈，以夜间痛为主。Inearlystage:generalasymptomatic;Inthelateseverepain,anditmainlyhappensatnight,治疗方法Treatment,化疗、内分泌治疗、分子靶向治疗等Chemotherapy,endocrinetherapy,moleculartargetedtherapy镇痛和其他支持治疗Analgesiaandothersupportivetreatments双膦酸盐治疗Diphosphonate手术治疗Operation放射治疗Radiationtherapy,双膦酸盐治疗Diphosphonate,适应症:Indications高钙血症Hypercalcemia骨痛Bonepain治疗和预防骨相关事件（SREs）Treatmentandpreventionofbonerelatedevents明确有骨转移的乳腺癌患者，应首先考虑给予双膦酸盐作为基础治疗Biphosphonateshouldbeconsideredasthebasictreatmentforpatientswithbreastcancerwhohavebeenidentifiedwithbonemetastasis,放射治疗Radiationtherapy,放疗是乳腺癌骨转移姑息性治疗的有效方法Radiotherapyisaneffectivemethodofpalliativetreatmentforpatientswithbonemetastasisofbreastcancer放疗的主要作用Themainroleofradiotherapy缓解骨疼痛Reliefofbonepain减少病理性骨折的危险Reducetheriskofpathologicalfracture放射治疗方法Treatment体外照射（首选方法）Externalirradiation(preferredmethod)放射性核素Radionuclide,手术治疗Operation,治疗方法：固定术、置换术和神经松解术Treatment:fixation,replacementandneurolysis治疗选择Treatmentoptions固定术：选择性用于病理性骨折或脊髓压迫，预期生存时间4周Fixationisusedforpati