Female breast cancer but speech, although in the screen and diagnose in early days up have already had a substantial progress, about still had 40% friends of diseases of breast cancer with 60% ～s to have already had an armpit to pour to flatteringly transfer while diagnose, this cell which represents breast cancer has already transfered to°from the breast partial focus non- breast to organize part, even representing other organs may have already had image to learn check the minuteness that can't see transfer.At past, these patients have 50% probabilities with 70% ～s after operation and around in 10 to transfer inside the occurrence obviously other organs as a result fatal.However, along with the progress of the assistance chemistry treatment and the hormone treatment, this this occurrence which transfers process after having already can stop or postpone.Track 75,000 researches(be called to oxford look back) that the patient of breast cancer do according to 1992 abroad, the assistance chemistry treatment can reduce to relapse annually of the opportunities reach to 24%.But include the usage of anthracycline(small red Mei) and taxane(the yew Chun) medicine along with the improvement of the assistance chemistry treatment prescription, we believe in the past decade of indirectly be subjected to the patient of the assistance chemistry treatment, relapse a rate be should even lower.This text is to the assistance chemistry treatment curing breast cancer the last new ideas or lately standard introduce:
The role of Anthracycline(be so called small red Mei) medicine
Iner common use have 2 kinds at the anthracycline(be so called small red Mei) of breast cancer treatment, 1 kind is a doxorubicin and 1 kind is an epirubicin.Along with the continuously improve of the assistance chemistry treatment prescription, the doctors have already find out the most suitable measure at the best recommendation of general breast cancer patient's anthracycline medicine, like FAC, FEC etc..Imply an anthracycline chemistry treatment prescription according to the result of many large researches in the meantime really better than used to use and don't contain anthracycline CMF prescription;Oxford look back to also discover, contain the anthracycline prescription ratio CMF to provide 3% survival helps more.Therefore generally think currently, if have no anthracycline the taboo disease(like heart failure) of the medicine, to the patient of breast cancer of armpit lymphoid knot masculine gender but speech, regard anthracycline as principle of the assistance chemotherapy prescription be most at least of request.
The role of Taxanes(the yew Chun) medicine
The yew Chun medicine which useds for breast cancer currently mainly has 2 kinds, 1 kind is a Pacific Ocean yew Chun(paclitaxel, the 剋 cancer is easy), 1 kind is an European yew Chun.(docetaxel discard a cancer to win)Pacific Ocean yew the Chun apply to cure at the breast cancer assistance chemistry of the international large clinical trial have 2;They are divided into 2 sets: patient, 1 set beat 4 this doxorubicin/cyclophosphamide(brief name AC) prescription, another in addition to 4 AC prescriptions, is beat 4 more of Pacific Ocean yew Chun, discover to beat 4 more of Pacific Ocean yew Chun as a result of that, two clinical trial all confirms to have no guest survival period(namely pointed a patient and relapse and survive) helpful, but an among those confirm more to expect to do good to the patient whole survival.(this kind of advantage's arrive have already keep on currently five years above)And an among those research also shows, this kind of advantage accepts the patient of body feminine gender to the hormone specially obvious.The conclusion is track a circumstance for five years under, 4 ACs add 4 Pacific Ocean yew and the prescription of the Chun really wants to compare only 4 ACs to be good friends with.But deny 4 ACs to add 4 Pacific Ocean yew Chuns to compare 6 times or be 8 FACs(or FEC) good friends with?Have already done a smaller scaled clinical research in the United States, discover as a result 4 FAC prescriptions add 4 Pacific Ocean yew Chuns and may compare 8 FAC prescriptions to be good friends with, but twos statisticsed up of meaning.
The Chun medicine of another yew-the European yew Chun is in breast cancer lend support to the research development of sex chemistry treatment to to compare Pacific Ocean yew Chun is night, however have already had a large and clinical research to confirm currently, 6 European yew Chun/doxorubicin/cyclophosphamide(brief name TAC) the treatment of the prescription has to be better than 6 treatments of FAC prescriptions have no disease survival period and whole survival period.The advantage in spite of accepts body masculine gender or the patients of feminine gender to the hormone all here it is thus clear that get, and transfer the patient of number less to benefit to the armpit lymphoid knot more.But TAC prescription's having a more obvious weakness be the circumstance that its marrow repress to compare with FAC, is severity, have 25% patients would because the leukocyte descend, fever but have to go to hospital.
According to top say, currently use the yew Chun medicine after postoperative ssistance the top of the chemistry treatment being a trend, being also an acceptable standard treatment, but denying truely of compare list regarding small red Mei medicine as principle of prescription at homology of giving number of times the bottom to be good friends with, tracking longer time(like decade), this kind of for don't need to relapse and survive of whether help still exists or not?That yew Chun be the medicine better?Then need time and more clinical researches to confirm.
Does the patient whom there is no armpit lymphoid knot transfer need to lend support to a sex chemistry treatment?
The large research which announces in stabbing Ge needle(Lancet) this to enrich an authority medical science magazine very much in 1998 confirm that the assistance chemistry treatment in spite of lymphoid to armpit knot masculine gender or feminine gender of the patients all have already lowered to relapse, extension survival of advantage.And some researches of molecular biologies also support a talk point currently:The armpit is lymphoid to knot feminine gender and armpit lymphoid knot masculine gender of the cell of breast cancer expresses in the gene and clinical progress up have no dissimilarity, two of different is discover time of sooner or later.The comparison can classify the cell of breast cancer in the gene and the top different type of the clinical performance of then the estrogen accept the masculine gender or feminine gender of body.Therefore transfer according to the armpit lymphoid knot currently it already have no come further distinction patient whether should accept or accept what assistance chemistry treatment of prescription, in the future may more"fine turn".In other words, in the near future, the patient may come to the chemistry need by"the quantity body order to make" according to four following main variables treatment, on being the molecular biology that the decision responds to the medicine to predict factor, two is pathology and molecular biology which decides that the disease relapse to prepare behind factor(like this deny an armpit to pour to flatteringly transfer), three is the patient's characteristic(like this deny to have other diseases, life expectancy, and the patient's expectation to the treatment etc.), four is treatment may take place of impatient or long-term side effect etc..Think currently, the estrogen accepts a body, it has been already have no, is still to decide that the patient accept what treatment the decision factor of most.Therefore, we also make a further discussion according to this.
The armpit is lymphoid to knot feminine gender, estrogen to accept a body a male patient an assistance chemistry to cure it an usage
According to the research, the assistance chemistry treatment can bring of clinical help, accept the patient of body masculine gender really to accept the patient of body feminine gender than the hormone in the estrogen to get small;Accept the patient of body feminine gender in the hormone, lend support to a sex chemistry treatment can lower to relapse of the risk reach to 30%, lower to die of the risk reach to 17%;But accept the patient of body masculine gender in the hormone, can lower 18% and 9% respectively just then.Therefore cure the top of the standard to have very much according to breast cancer authority 2003 St. Gallen standard, if the patient belong to hormone to accept body masculine gender;The focus of its breast cancer is small in or equal 2 cms, plus organization or pit to divide ratings for first degree(point to divide better), and patient's age be old in or equal a 35-year-old, the patient then after operation can not need to accept an assistance chemistry treatment and even can also not need a hormone treatment.Whereas, if the above-mentioned any condition not agree with to match, be also say, focus more than 2 cms, or organizations or pit of breast cancer divide ratings for second degree or x-rated(medium etc. divide or divide badly), or patient's age be young in 35 years old, then in addition to wanting to accept a hormone treatment, the patient should also consider accepting an assistance chemistry a treatment.
The hormone accepts a body once deciding to accept the assistance chemistry treatment, the male patient thinks currently prescription(like CMF) with the anthracycline doesn't don't have the way to bring breast cancer to after operation accept a tamoxifen treatment to stop menstruating behind women further advantage;But can imply anthracycline prescription(like FAC) to use before tamoxifen, then can lower this kind of opportunity that the women relapse to reach to 27% and the opportunity to lower to die reaches to 24%.Therefore, the prescription which implies anthracycline is better choice, but must whether patient can bear this kind treatment prescription to be included in consideration or not.
The armpit is lymphoid to knot feminine gender, hormone to accept body feminine gender a patient an assistance chemistry to cure it an usage
Accept the patient of body feminine gender in the hormone, the hormone treatment(like tamoxifen) did good.The patient of this armpit lymphoid knot feminine gender, the key problem lie in if the focus of the patient's breast cancer be very small(less than 2 cms), whether patient have to also accept an assistance chemistry a treatment or not?If basis 2003 St. Gallen standard, as long as is the patient whom the hormone accepts body feminine gender, in spite of have an armpit the lymphoid knot to transfer, in spite of be taken bad cooking stove size at first, have to accept the assistance chemistry treatment.The abroad has already had some software to compute the probability that dies in breast cancer according to various patient's condition to provide patient and doctor with the reference currently, Be the basis which cures a choice, expect in the future can also have similar software can used for our country women compatriot up.
Will prospect in the future
Believe in the near future, will some doctors and the friend inquisitive problem of disease acquire more explicit solution, include whether the patient whom the trastuzumab(Herceptin(r), the He cancer is even) excessively expresses in the HER-2/neu should used for lending support to a sex chemistry treatment or not one by one?What is a lymphoid knot masculine gender and feminine gender patient quite the cheese ssistance chemistry treatment prescription?What is the best hormone treatment method of the patient whom the hormone accepts the body male breast cancer?Molecular biology technique(such as gene tiny be apart from array analysis a technique) whether the ability correct desire measures a prepare of patient behind?Can you guide the choice of the doctor to the treatment method to make more a sound judgment?We hope after these problems work°out, the friends of the disease of breast cancer all can have 1 to no longer be full of terrified future, under the treatment method that accuracy very high, "tailor", breast cancer will take leave forever with word in"incurable sickness"!
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