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Прогностическое значение локального и системного лечения при раке молочной железы I стадии
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Аннотация
Выполнен ретроспективный анализ течения болезни у 1341 больной раком молочной железы (РМЖ) I стадии (T1N0M0); пациентки получили радикальное хирургическое лечение в РОНЦ им. Н.Н.Блохина РАМН и Клинике РМАПО с 1985 по 2012 г., а также адъювантную лучевую и/или системную терапию. Были выявлены существенные изменения в подходах к лечению в течение 20 лет: несмотря на то что доля органосохраняющего хирургического и лучевого лечения осталась неизменной, произошло перераспределение структуры локального лечения. Лучевая терапия стала обязательным компонентом органосохраняющего лечения и дополнилась проведением «буста» на ложе удаленной опухоли, что позволило обеспечить высокий уровень локального контроля (доля локальных рецидивов сократилась в течение 20 лет с 14,2 до 3%). Адъювантная лекарственная терапия при РМЖ I стадии стала использоваться у подавляющего большинства (86,7%) пациенток: существенно увеличилась доля женщин, получивших эндокринотерапию (с 20,7 до 44,3%), химиотерапию – ХТ (с 2,6 до 13,6%) или химиогормонотерапию (с 8,4 до 28,8%). Произошли важные изменения в режимах ХТ: на смену безантрациклиновым режимам (CMF) пришли антрациклинсодержащие комбинации, после 2005 г. – таксаны, а у пациенток с HER2-позитивным раком – трастузумаб. Сократилась доля пациенток, получающих эндокринотерапию только тамоксифеном (с 84,2 до 52,4%), в пользу других режимов (ингибиторов ароматазы – ИА и последовательных режимов). Активное внедрение в клиническую практику адъювантной системной терапии и усовершенствование ее методик привело более чем к 6-кратному сокращению доли отдаленных рецидивов болезни (с 27,3 до 4,0%), что благоприятно отразилось на показателях отдаленной выживаемости при РМЖ I стадии.
Ключевые слова: рак молочной железы I стадии, эволюция локального и системного лечения, адъювантная лекарственная терапия, рецидивы рака молочной железы, выживаемость при раке молочной железы.
Ключевые слова: рак молочной железы I стадии, эволюция локального и системного лечения, адъювантная лекарственная терапия, рецидивы рака молочной железы, выживаемость при раке молочной железы.
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A retrospective analysis of the course of the disease in 1341 patients with breast cancer stages I (T1N0M0) was made; patients received radical surgery ± adjuvant radiotherapy and/or systemic therapy in the Blokhin RCRC and Clinic of RMAPE from 1985 to 2012. There were significant changes in the approach to treatment for 20 years; the proportion of breast-conservative surgery and radiotherapy remained unchanged, however there was a redistribution structure of local treatment. Radiotherapy has become essential component of breast-conservative treatment and supplemented with a «boost» in the tumor bed, thus ensuring a high level of local control (the proportion of local recurrence was reduced to 20 years from 14,2 to 3%). Adjuvant systemic therapy in breast cancer stage I was used in the majority of patients (86,7%) significantly increased the proportion of women who received endocrinotherapy (from 20,7 to 44,3%), chemotherapy (from 2,6 to 13,6%), or both systemic therapy (from 8,4 to 28,8%). There have been important changes in regimes of chemotherapy to replace non-anthracycline combination (CMF) came to anthracycline and taxanes after – 2005 later and trastuzumab – in patients with HER2-positive breast cancer. The part of patients received endocrinotherapy tamoxifen alone descreased (from 84,2 to 52,4%) in favor of other regime (aromatase inhibitors and sequential modes). Active introduction into clinical practice of adjuvant systemic therapy and improvement of its methods has led to more than 6-fold reduction in the proportion of distant recurrence of disease (from 27,3 to 4,0%) had a positive impact on long-term survival rates for breast cancer stage I.
Key words: breast cancer stage I, development of local and systemic treatment, adjuvant system therapy, recurrences of breast cancer, survival in breast cancer.
Полный текст
Список литературы
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2. Ignatiadis M, Sotiriou C. Luminal breast cancer: from biology to treatment. Nat Rev Clin Oncol 2013; 10 (9): 494–506.
3. Mihály Z, Gyõrffy B. HER2-positive breast cancer: available targeted agents and biomarkers of therapy response. Magy Onkol 2013; 57 (3): 147–56.
4. Mohamed A, Krajewski K, Cakar B, Ma CX. Targeted therapy for breast cancer. Am J Pathol 2013; 183 (4): 1096–112.
5. Goldhirsch A. Personalized adjuvant therapies. Lessons from the past: The opening address by the St. Gallen 2013 award recipient. Breast 2013; 222: s3–7.
6. Sestak I, Dowsett M, Zabaglo L et al. Factors predicting late recurrence for estrogen receptor-positive breast cancer. J Natl Cancer Inst 2013; 105 (19): 1504–11.
7. Ismaili N, Elmajjaoui S, Tahri A et al. Trastuzumab in early breast cancer. Presse Med 2013; 42 (7–8): 1069–80.
8. Harbeck N, Thomssen C, Gnant M. St. Gallen 2013: brief preliminary summary of the consensus discussion. Breast Care (Basel) 2013; 8 (2): 102–9.
9. Petrelli F, Coinu A, Cabiddu M et al. Five or more years of adjuvant endocrine therapy in breast cancer: a meta-analysis of published randomised trials. Breast Cancer Res Treat 2013; 140 (2): 233–40.
10. Coudert B, Asselain B, Campone M et al. Extended benefit from sequential administration of docetaxel after standard fluorouracil, epirubicin, and cyclophosphamide regimen for node-positive breast cancer: the 8-year follow-up results of the UNICANCER-PACS01 trial. Oncolog 2012; 17 (7): 900–9.
11. Christinat A, Di Lascio S, Pagani O. Hormonal therapies in young breast cancer patients: when, what and for how long? J Thorac Dis 2013; 5 (Suppl. 1): s36–46.
12. Barron TI, Cahir C, Sharp L, Bennett K. A nested case-control study of adjuvant hormonal therapy persistence and compliance, and early breast cancer recurrence in women with stage I–III breast cancer. Br J Cancer 2013; 109 (6): 1513–21.
13. Hernandez-Aya LF, Gonzalez-Angulo AM. Adjuvant systemic therapies in breast cancer. Surg Clin North Am 2013; 93 (2): 473–91.
14. De Laurentiis M, Cancello G, D’Agostino D et al. Taxane-based combinations as adjuvant chemotherapy of early breast cancer. A meta-analysis of randomized trials. J Clin Oncol 2008; 26: 44–53.
15. Mackey JR, Martin M, Pienkowski T et al. Adjuvant docetaxel, doxorubicin, and cyclophosphamide in node-positive breast cancer: 10-year follow-up of the phase 3 randomised BCIRG 001 trial. Lancet Oncol 2013; 14 (1): 72–80.
16. Eiermann W, Pienkowski T, Crown J et al. Phase III study of doxorubicin/cyclophosphamide with concomitant vs sequential docetaxel as adjuvant treatment in patients with human epidermal growth factor receptor 2-normal, node-positive breast cancer: BCIRG 005 trial. J Clin Oncol 2011; 29 (29): 3877–84.
17. Slamon D, Eiermann W, Robert N et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med 2011; 365 (14): 1273–83.
18. Sgroi DC, Sestak I, Cuzick J et al. Prediction of late distant recurrence in patients with oestrogen-receptor-positive breast cancer: a prospective comparison of the breast-cancer index (BCI) assay, 21-gene recurrence score, and IHC4 in the Trans ATAC study population. Lancet Oncol 2013; 14 (11): 1067–76.
19. Metzger-Filho O, Sun Z, Viale G et al. Patterns of recurrence and outcome according to breast cancer subtypes in lymph node-negative disease: results from International Breast Cancer Study Group Trials VIII and IX. J Clin Oncol 2013; 31 (25): 3083–90.
20. Wolfe E, Corsetti R, Bolton JS et al. The evolution in management of patients with subcentimeter, node-negative, triple-negative breast cancer. Am J Surg 2013.
21. Nothacker M, Duda V, Hahn M et al. Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review. BMC Cancer 2009; 9: 335.
22. Wan Y, Gao X, Mehta S. Indirect costs associated with metastatic breast cancer. J Med Econ 2013; 16 (10): 1169–78.
23. Keen JD. Analysis of health benefits and cost-effectiveness of mammography for breast cancer. Ann Intern Med 2011; 155 (8): 566.
Авторы
И.В.Колядина1,2, И.В.Поддубная1,2, О.П.Трофимова1,2, Д.В.Комов2, А.И.Карселадзе2, В.Д.Ермилова2, Я.В.Вишневская2, Г.А.Франк1, С.М.Банов3
1 ГБОУ ДПО РМАПО Минздрава РФ, Москва
2 ФГБУ Российский онкологический научный центр им. Н.Н.Блохина РАМН, Москва
3 Клиника ГБОУ ДПО РМАПО Минздрава РФ, Москва
1 ГБОУ ДПО РМАПО Минздрава РФ, Москва
2 ФГБУ Российский онкологический научный центр им. Н.Н.Блохина РАМН, Москва
3 Клиника ГБОУ ДПО РМАПО Минздрава РФ, Москва
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I.V. Kolyadina, I.V.Poddubnaya, O.P.Trofimova, D.V.Komov, A.I.Karseladze, V.D.Ermilova, Ya.V.Vishnevskaya, G.A.Frank, S.M.Banov
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