乳腺癌根治术后放疗课件整理

乳腺癌术后放疗(二)乳腺癌(改良)根治术后放疗宋锐今乳腺癌的保乳术乳腺癌的根治术及改良根治术☆保乳术是指完整切除肿块块及腋淋巴结清扫。◆乳腺癌根治手术是指整个乳房,胸大肌,胸小肌、腋窝及锁骨下淋巴结的整块切除。今改良术由两种,一种是保留胸大肌,切除胸小肌,一种是指保留胸大小肌,前者淋巴结清除范围与根治术相仿,后者不能清除腋上组淋巴结保乳术的相对指征:1肿瘤≤30cm2腋窝淋巴结未见肿大3单个及非多中心或病灶4.大乳房5年青今乳腺根治术后放疗NarionalComprehensiveNCCNCancerNetworkNCCNClinicalPracticeGuidelinesinOncology(NCCNGuidelines)BreastcancerVersion3.2019NCCN.orgNccnGuidelinesforPatientsavailableatnccn.colContinueNCCNCaonprnensvNCCNGuidelinesVersion3.2019StagingNCCNGuidelinesIndexBreastCancerTableofcontenNetwork"BreastCancerDiscussionTNMStagingSystemForBreastCancereextensiontothechestwallrimaryTumor(T)TheTclassificationoftheprimarysgeshessbemeasrredstotheeaestmilameterfthefumersizeth.Note:Invasionofthedermisalonedoesnotqualifyhestwall,notincludingonlmmatorycarcinomaimarytumorcategonzerbasednthesizedcharactsiesortheisease.althoughtheTumor520lessingrTImiTumors1mmingreatestdimensionbuts5mmingreatestdimensionTumor>5mmbut510mmingreatestdimensioT1cTumor>10mmbuts20mmingreatestdimensionstagingcontinuedonnextpage(51-2)ScNo,c3013none.TheNOCNGadeirecandtasianuwnotterepodcadhnangtmaST-1ComprchensiveNCCNGuidelinesVersion3.2019StagingNCCNGuidelinesIndexNCCNncerBreastCancerTable1(continued)Pathologic(pN)(continued)lymphnodeslymphnodebiapsybutnotclinicallydetectedmorethanclinicallydetectedisdefinedasnotdetectedbyimagingstudiesDN1bMetastasenalmammarynodeswithbasedonfneneedleaspirationbiopsywithcyclonicexaminationmacrometastasesdetectedbysentinellymphnodebiopsystantMopN2Metastasesin4-9axillarylymphnodes;orinclinicalllargerthan0.2mminapatientwithoutsymptomsorsignspNAdepositgreaterthan2.0nymphnodes(atleastonetumorM1Distantdetectablmetastasesasdeterminedbyclassicclinicalandclinicallydetected"intemalmammarylymphnodesintheabofaxillarybymphnodePMetastasesintenorPNaStagingcontinuedonnextpageST-41STNCCNGuideinesIndexNCCNCancerNCCNGuidelinesVersion3.2019StagingBreastCancerTbleoNetworkBreastCanceNATOMICSTAGEPROGNOSTICGROUPSstagestage旧BMMMMM加G2Intermediatecombinedhistologiegrade(mederatelyfavorable)therwisespecfied)MPaget'sdiseaseandintraductTDastasesonlyareexcludedfromclassifiedStageIBInvasiveCarcinomaslDshouldbecirDuctalaedullarywithlymphoidstromarecarriedoutMucronTHamisLFritscheH,MennelRetal.AmericanSocietyofClinicalOncologyPostneoadjuvanttherapyisdesignatedwithycoryppremo.ofnote,nothereisacompletepathologicresponse(CR)adjuvanttherapy,forexample,ypTDypNOcMOHISTOLOGICGRADE(G0C以R知如shouldbegraded.ThcombinedheinclusionofthisinformationhereindoesnotauthorizeessedSpringersBM,onbehalfoftheAJCCwordn3ulEau3西Nancarhawakhcicu,Nihsenst.TheNCCNGaklee'andttshuaanmayndteregodacadhn