Umdlavuza wesibeletho
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 umdlavuza webele treatment, the application of chemotherapy and molecular targeted therapy in breast metastasis has received more and more attention.
I-Metastasis yobuchopho yomdlavuza webele
Eminyakeni yamuva nje, ngokuthuthuka okuqhubekayo kokuxilongwa nokwelashwa, isikhathi sokusinda kweziguli siye sande kakhulu, futhi izehlakalo ze-metastases yobuchopho (i-metastasis yobuchopho, i-BM) nayo yanda kakhulu. Cishe i-30% yeziguli ekugcineni zizoba nama-metastases ebuchosheni, futhi isikhathi sokusinda ngemva kwe-metastases yobuchopho yizinyanga ezi-2 ~ 14. Umdlavuza webele unezigameko eziningi zokumetastasis kobuchopho kanye nokubikezela okubi. Sekuyisici esibalulekile esithinta izinga lempilo nokuphila. I-prognosis nokwelashwa kwe-BM bekulokhu kugxilwe kanye nobunzima bemibuthano yezemfundo. Kubalulekile ukuhlaziya izici zayo zomtholampilo futhi uthole ukwelashwa okusebenzayo. Futhi umsebenzi ophuthumayo. Lesi sihloko sibuyekeza ukubikezelwa komtholampilo kanye nokwelashwa kwe-BCBM.
Izici zokubikezela ze-metastases yobuchopho kusuka kumdlavuza webele
Olunye ucwaningo lubonise ukuthi ukubikezelwa kwe-BCBM kuhlobene nezici ezinjengobudala, ukuhlukaniswa kwamangqamuzana, i-extracranial metastasis, inani lezilonda ze-BM, indawo enkulu yezilonda, kanye nesikolo se-KPS. Abacwaningi baye basungula amamodeli okuhlola okubikezelwa okubikezelwa okusekelwe kulezi zici ezithonya ezingenhla, bezama ukuhlukanisa ngokuphumelelayo iziguli ezinama-metastases ahlukene obuchopho bokubikezela ukusiza ukukhetha amasu omtholampilo.
Ukwelashwa komdlavuza webele we-brain metastatic
Ukwelashwa kwama-metastases ebuchosheni asuka kumdlavuza webele kufanele kuhlolwe kabanzi ngokusekelwe ezicini ezifana nesimo esijwayelekile sesiguli, indawo yesilonda, nokulawulwa ngaphandle kobuchopho ngaphambi kokunquma uhlelo lokwelapha. Njengamanje, ukuhlinzwa, i-WBRT, kanye ne-SRS kusewumugqa wokuqala wokwelapha we-BCBM. Inqubekelaphambili yenziwe futhi ekwelapheni ngamakhemikhali nasekwelashweni okuhloswe kwamangqamuzana.
Ukwelashwa kweHormone yomdlavuza webele we-metastatic
The commonly used drug is dexamethasone, and hormone therapy is not required for patients with asymptomatic brain metastases. Dexamethasone can relieve the symptoms caused by edema in a short time by restoring the elasticity of arterial blood vessels and reducing the permeability of capillaries. The recommended starting dose of dexamethasone is 4 ~ 8mg / d; when brain metastases are secondary to severe cerebral edema and high intracranial pressure, it is recommended to use dexamethasone at a dose of 16mg / d or greater, which should be gradually reduced when discontinued. the amount.
Ukwelashwa kokuhlinzwa komdlavuza webele we-metastatic
Ilungele kakhulu iziguli ezinesibhamu esisodwa kanye ne-KPS> 70. Ngokomtholampilo, u-20% -30% weziguli zifanele ukwelashwa kokuhlinzwa. Izinzuzo zayo ukuthi ingakwazi ukukhulula ngokushesha izimpawu, ithole izibonelo ze-pathological, futhi ithuthukise izinga lokulawula lendawo. Isimo sokuhlinzwa kuma-metastases amaningi obuchopho sisantula idatha efanele neziphetho.
I-radiotherapy yobuchopho bonke
For patients with intracranial lesions> 3, the total effective rate of whole-brain radiotherapy alone was 60 to 80%. About 70% of patients had improved symptoms and prolonged the average survival time of 3 to 6 months. Stereotactic Radiosurgery (SRS)It is generally believed that SRS is mainly suitable for patients with 3 or less lesions, a diameter of <3.0 cm, and a small space effect, especially for tumors that are not easily accessible during surgery and are located in important functional areas. But SRS has been studied more and more in multiple brain metastases, and it seems feasible.
I-Chemotherapy yomdlavuza webele we-metastatic
The efficacy of chemotherapy on BCBM is limited because the drug has difficulty crossing the blood-brain barrier. Some studies in recent years have shown that the combination of chemotherapy and radiotherapy can improve the efficacy. Because radiation therapy opens the blood-brain barrier, drugs can enter the skull to exert anti-tumor effects. Although chemotherapeutic drugs are difficult to achieve a clear antitumor effect in the skull, effective control of extracranial lesions can improve the quality of life and prolong the survival time of patients.
Ukwelashwa okuhlosiwe komdlavuza webele we-metastatic
With the continuous understanding of the mechanism of isisu 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 ama-gliomas, and there are few studies in brain metastases such as breast cancer and lung cancer, and further research is still needed.
I-Endocrine therapy yomdlavuza webele we-metastatic
There is very little research data on endocrine therapy in BCBM treatment. Because endocrine therapy has a slower onset of action, and most patients with BM have a poor prognosis and need to control local symptoms as soon as possible, endocrine therapy is not recommended as first-line treatment for BCBM. In summary. The high incidence and poor prognosis of brain metastases in breast cancer have become clinically difficult problems. It is generally believed that factors such as age, KPS score, receptor status, number of brain metastases, and stability of extracranial lesions affect the prognosis of patients, but the current prognostic assessment model has limited predictive power and needs to be further improved and improved. In terms of treatment, surgery and radiation therapy are still the main treatment methods, and the status of chemotherapy and molecular targeted drugs has gradually increased.
