Kansa yepabonde
With the advancement of breast cancer diagnosis and treatment, the survival time of breast cancer patients has prolonged significantly, but the incidence of breast cancer brain metastases (BCBM) has gradually increased. This article reviews recent clinical studies related to the survival prognosis and treatment of breast metastases from breast cancer. It is generally believed that factors such as age, KPS score, receptor status, number of brain metastases, and control of extracranial lesions affect patient prognosis. Surgery, whole brain radiotherapy (WBRT), and stereotactic radiosurgergy (SRS) are currently the first-line treatments for brain metastases. With the development of comprehensive kenza yebonde treatment, the application of chemotherapy and molecular targeted therapy in breast metastasis has received more and more attention.
Brain metastasis yekenza yemazamu
Mumakore achangopfuura, nekuenderera mberi kwekuvandudzwa kwekuongororwa uye kurapwa, iyo nguva yekurarama yevarwere yakareba zvakanyanya, uye chiitiko chehuropi metastases (brain metastasis, BM) yakawedzera zvakanyanya. Vanenge makumi matatu muzana evarwere vanozopedzisira vaita metastases yehuropi, uye iyo yekupona nguva mushure mehuropi metastases ndeye 30 ~ gumi nemwedzi. Gomarara repazamu rine huwandu hwakanyanya hwehuropi metastasis uye kufungidzira kwakashata. Yakave chinhu chakakosha kukanganisa hupenyu hwehupenyu uye kupona. Kufungidzira uye kurapwa kweBM kwagara kuri iko kutarisisa uye kuoma kwematenderedzwa edzidzo. Izvo zvakakosha kuti uongorore maitiro ayo emakiriniki uye uwane marapirwo anoshanda. Uye rinokurumidza basa. Ichi chinyorwa chinoongorora kuchipatara kufungidzira uye kurapwa kweBBBM.
Kufungidzira zvinhu zvehuropi metastases kubva kune kenza yemazamu
Zvimwe zvidzidzo zvakaratidza kuti kufungidzira kweBBBM kunoenderana nezvinhu zvakaita sezera, mamorekuru kupatsanura, metastasis yekuwedzera, huwandu hwezvironda zveBM, nzvimbo yakakura yezvironda, uye mamakisi eKPS. Vatsvagiri vakagadza akasiyana fungidziro yekuongorora mamodheru zvichibva pane zviri pamusoro zvinhu zvinokonzeresa, kuyedza kunyatso kusiyanisa varwere vane akasiyana fungidziro yehuropi metastases kubatsira sarudzo yemazano emakiriniki.
Kurapa kwehuropi metastatic kenza yemazamu
Kurapa kwehuropi metastases kubva kune kenza yemazamu kunofanirwa kuongororwa zvakaringana zvichibva pazvinhu zvakaita seyakajairika mamiriro emurwere, nzvimbo yechironda, uye kudzora kwekuwedzera usati wafunga chirongwa chekurapa. Parizvino, kuvhiyiwa, WBRT, uye SRS ichiri chekutanga kurapwa kweBCBM. Kufambira mberi kwakaitwawo mu chemotherapy uye mamorekuru akanangwa ekurapa.
Hormone kurapwa kwekenza yemazamu yemastastatic
Mushonga unowanzoshandiswa idexamethasone, uye kurapwa kwehomoni hakudiwi kune varwere vane asymptomatic brain metastases. Dexamethasone inogona kubvisa zviratidzo zvinokonzerwa ne edema munguva pfupi nekudzoreredza kusimba kwetsinga dzeropa uye kuderedza kupera kwema capillaries. Iyo yakakurudzirwa yekutanga dose ye dexamethasone ndeye 4 ~ 8mg / d; kana metastases yehuropi iri yechipiri kusvika kune yakanyanya cerebral edema uye yakanyanya intracranial pressure, zvinokurudzirwa kushandisa dexamethasone pamwero we 16mg / d kana kupfuura, iyo inofanirwa kudzikiswa zvishoma nezvishoma kana ikamiswa. mari yacho.
Kuvhiya kurapwa kwekenza yemazamu yemastastatic
Inonyanya kukodzera kuvarwere vane single shots uye KPS> 70. Kiriniki, 20% -30% yevarwere yakakodzera kurapwa kurapwa. Zvakanakira izvi ndezvekuti inogona kukurumidza kubvisa zviratidzo, kuwana zvimiro zvehurwere, uye kugadzirisa mwero wekutonga kwenzvimbo. Mamiriro ekuvhiyiwa mune dzakawanda huro metastases achiri kushaya akakosha dhata uye mhedzisiro.
Uropi hwese radiotherapy
Kune varwere vane maronda emukati memusoro> 3, huwandu hunoshanda hwehuropi hwese-radiotherapy chete yaive 60 kusvika 80%. Inenge 70% yevarwere vakanga vakavandudza zviratidzo uye vakawedzera nguva yenguva yekupona ye3 kusvika kumwedzi mitanhatu. Stereotactic Radiosurgery (SRS) Zvinotendwa kuti SRS inonyanya kukodzera varwere vane 6 kana kushoma maronda, dhayamita ye<3 cm, uye diki space effect, kunyanya kumamota asingasvikike nyore panguva yekuvhiyiwa uye anowanikwa munzvimbo dzakakosha. nzvimbo dzinoshanda. Asi SRS yakadzidzwa zvakanyanya mune dzakawanda uropi metastases, uye zvinoita sekunge zvinogoneka.
Chemotherapy yekenza yemazamu yemastastatic
Kushanda kwechemotherapy paBCBM kushoma nekuti mushonga unonetseka kuyambuka chipingamupinyi cheropa-uropi. Zvimwe zvidzidzo mumakore achangopfuura zvakaratidza kuti kusanganiswa kwechemotherapy uye radiotherapy kunogona kuvandudza kushanda. Nekuti radiation therapy inovhura iyo yeropa-brain barriers, mishonga inogona kupinda mudehenya kuti iite anti-bundu mhedzisiro. Kunyange zvazvo chemotherapeutic mishonga yakaoma kuwana yakajeka antitumor effect mudehenya, kudzora kunobudirira kwezvipembenene zve extracranial zvinogona kuvandudza mararamiro ehupenyu uye kuwedzera nguva yekurarama kwevarwere.
Targeted Therapy yekenza yemazamu yemastastatic
With the continuous understanding of the mechanism of tumarara formation and metastasis, molecular targeted therapy has become a routine treatment strategy for malignant tumors. Bevacizumab combined with radiotherapy is mainly used for the treatment of gliomas, and there are few studies in brain metastases such as breast cancer and lung cancer, and further research is still needed.
Endocrine kurapa kwekenza yemazamu yemastastatic
Pane shoma shoma data rekutsvagisa pane endocrine kurapwa muBCBM kurapwa. Nekuti endocrine therapy ine kunonoka kwekuita kwekuita, uye varwere vazhinji vane BM vane fungidziro isina kunaka uye vanoda kudzora zviratidzo zvemuno nekukurumidza sezvinobvira, endocrine therapy haikurudzirwe sekutanga kurapa kweBCBM. Muchidimbu. Chiitiko chepamusoro uye kutadza kufungidzira kweuropi metastases mugomarara rezamu zvave matambudziko akaomarara. Zvinowanzotendwa kuti zvinhu zvakadai sezera, chikamu cheKPS, chimiro chekugamuchira, nhamba yemetastases yeuropi, uye kugadzikana kwezvipembenene zve extracranial zvinokanganisa kufungidzira kwevarwere, asi ikozvino maitiro ekuongorora maitiro ane simba shoma rekufungidzira uye inoda kuvandudzwa nekuvandudzwa. . Panyaya yekurapa, kuvhiyiwa uye kurapwa nemwaranzi ichiri nzira huru dzekurapa, uye chimiro chechemotherapy nemishonga inonangwa nemakemikari yakawedzera zvishoma nezvishoma.
