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1、乳腺癌骨转移和乳腺癌骨转移和骨相骨相 关疾病的诊断和治疗关疾病的诊断和治疗 Diagnosis and treatment of Diagnosis and treatment of bone metastasis of breast bone metastasis of breast cancer cancer 1 流行病学流行病学EpidemiologyEpidemiology n n 骨转移的比例仅次于肺 肝脏的转移骨转移的比例仅次于肺 肝脏的转移 n n The ratio of bone metastasis is secondary to The ratio of bone met
2、astasis is secondary to lung and liverlung and liver n n 通常为通常为多发多发 单发转移者仅占 单发转移者仅占10 10 n n Usually for Usually for multiplemultiple bone metastasis only bone metastasis only 10 for single10 for single n n 80 80 为为中轴骨中轴骨 如脊柱和骨盆 如脊柱和骨盆 n n 80 for 80 for axial skeletonaxial skeleton such as the spine
3、 and such as the spine and pelvispelvis 2 目目 录录CatalogueCatalogue 1 1 乳腺癌骨转移概述乳腺癌骨转移概述 1 Overview1 Overview 二二 乳腺癌骨转移诊断方法乳腺癌骨转移诊断方法 2 Diagnostic method2 Diagnostic method 三三 乳腺癌骨转移临床表现乳腺癌骨转移临床表现 3 Clinical manifestation3 Clinical manifestation 四四 乳腺癌骨转移治疗乳腺癌骨转移治疗 4 Treatment 4 Treatment 3 概概 述述 Over
4、viewOverview l l 骨转移是乳腺癌骨转移是乳腺癌最常见最常见的的远处转移远处转移部位部位 l l Bone metastasis is Bone metastasis is the most the most common common distant distant metastasesmetastases in breast cancer patients in breast cancer patients l l 晚期乳腺癌骨转移发生率为晚期乳腺癌骨转移发生率为65 65 75 75 l l The incidence of bone metastasis in termi
5、nal breast The incidence of bone metastasis in terminal breast cancer is cancer is 65 65 75 75 l l 骨痛 骨相关事件 骨痛 骨相关事件 SREsSREs 及生活质量降低是乳腺癌骨转 及生活质量降低是乳腺癌骨转 移的常见并发症移的常见并发症 l l Bone pain bone related events SREs and reduced Bone pain bone related events SREs and reduced quality of life are common compli
6、cations of bone quality of life are common complications of bone metastasis of breast cancermetastasis of breast cancer 参考文献参考文献 referencesreferences n n 1 Coleman RE Cancer Treat Rev 2001 Jun 27 3 165 76 2 John R Johnson Grant Williams et al J Clin Oncol 21 1404 1411 3 Kinnane N Eur J 1 Coleman RE
7、Cancer Treat Rev 2001 Jun 27 3 165 76 2 John R Johnson Grant Williams et al J Clin Oncol 21 1404 1411 3 Kinnane N Eur J Oncol Nurs 2007 11 Suppl 2 S28 31 Epub 2007 Sep 4 Oncol Nurs 2007 11 Suppl 2 S28 31 Epub 2007 Sep 4 4 诊断方法诊断方法 DiagnosisDiagnosis l l 骨转移骨转移初筛初筛诊断方法 骨放射性核素扫描 诊断方法 骨放射性核素扫描 ECTECT l
8、 l The The preliminary screening methodpreliminary screening method of bone of bone metastasismetastasis ECTECT l l 推荐用于出现骨疼痛 骨折 推荐用于出现骨疼痛 骨折 AKPAKP升高 或高钙血升高 或高钙血 症等可疑骨转移的常规初筛诊断检查症等可疑骨转移的常规初筛诊断检查 l l It is recommended to be used for patients of It is recommended to be used for patients of bone pain
9、fracture AKP elevation or bone pain fracture AKP elevation or hypercalcemia hypercalcemia l l 乳腺癌分期 乳腺癌分期 T3N1M0T3N1M0患者常规检查患者常规检查 l l Routine examination of patients with breast Routine examination of patients with breast cancer stage T3N1M0 cancer stage T3N1M0 l l 复发转移乳腺癌复发转移乳腺癌患者的常规检查患者的常规检查 l l
10、Routine examination of patients with Routine examination of patients with recurrent recurrent metastasismetastasis 5 l l 骨转移的影像学骨转移的影像学确诊确诊检查方法 骨检查方法 骨X X线线 CT MRI CT MRI l l Confirmed Confirmed Radiographic diagnosisRadiographic diagnosis of bone of bone metastasis X ray CT MRImetastasis X ray CT M
11、RI l l 60 78 60 78 溶骨性溶骨性破坏 破坏 10 20 10 20 成骨性 成骨性 12 20 12 20 混混 合性合性 l l Osteolysis Osteolysis 60 78 ossify 10 20 mixed 12 60 78 ossify 10 20 mixed 12 20 20 l l 骨活检 诊断乳腺癌骨转移的骨活检 诊断乳腺癌骨转移的金标准金标准 l l Biopsy Biopsy Diagnostic criteriaDiagnostic criteria for bone metastasis in for bone metastasis in b
12、reast cancerbreast cancer 6 7 8 9 临床表现临床表现Clinical manifestationClinical manifestation l l 症状 疼痛 病理性骨折 高钙血症 肢体功能障碍等症状 疼痛 病理性骨折 高钙血症 肢体功能障碍等 l l Symptoms Symptoms pain pain pathological pathological fracture fracture hypercalcemia and limb dysfunctionhypercalcemia and limb dysfunction l l 乳癌骨转移特点 早期一
13、般无症状 晚期疼痛剧烈 以乳癌骨转移特点 早期一般无症状 晚期疼痛剧烈 以夜夜 间痛间痛为主 为主 l l In In e early arly stagestage general general asymptomatic asymptomatic In In the the latelate severe pain and itsevere pain and it mainly happens at mainly happens at nightnight 10 治疗方法治疗方法Treatment Treatment l l 化疗 内分泌治疗 分子靶向治疗等化疗 内分泌治疗 分子靶向治疗等
14、 l l Chemotherapy endocrine therapy molecular Chemotherapy endocrine therapy molecular targeted therapytargeted therapy l l 镇痛和其他支持治疗镇痛和其他支持治疗 Analgesia and other Analgesia and other supportive treatmentssupportive treatments l l 双膦酸盐治疗双膦酸盐治疗 Diphosphonate Diphosphonate l l 手术治疗手术治疗 OperationOperati
15、on l l 放射治疗放射治疗 Radiation therapyRadiation therapy 11 双膦酸盐治疗双膦酸盐治疗 Diphosphonate Diphosphonate l l 适应症适应症 Indications Indications 高钙血症高钙血症 HypercalcemiaHypercalcemia 骨痛骨痛 Bone painBone pain 治疗和预防骨相关事件 治疗和预防骨相关事件 SREsSREs Treatment and prevention of bone related Treatment and prevention of bone relat
16、ed eventsevents 明确有骨转移的乳腺癌患者 应首先明确有骨转移的乳腺癌患者 应首先考考虑给予虑给予双膦酸盐双膦酸盐作作 为为基础基础治疗治疗 BiphosphonateBiphosphonate should be considered as the should be considered as the basic basic treatmenttreatment for patients with breast cancer who have for patients with breast cancer who have been identified with been identified with bone metastasisbone metastasis 12 13 放射治疗放射治疗 Radiation therapyRadiation therapy l l 放疗放疗是乳腺癌骨转移是乳腺癌骨转移姑息性治疗姑息性治疗的有效方法的有效方法 l l RadiotherapyRadiotherapy is an effective method of is an
