Adjuvant treatment Tamoxifen for 5 years ER or uncertain Risk reduction for contralateral breast cancer optional AI may also be considered
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1 共識診斷 臨床檢查 主要治療 輔助治療 術後追蹤 DCIS TisN0M0 LCIS TisN0M0 ER/PR/Her-2 ER/PR/Her-2 1. Partial mastectomy SLNB whole breast radiation therapy 2. Total mastectomy SLNB reconstruction Risk reduction surgery Adjuvant treatment Tamoxifen for 5 years ER or uncertain Risk reduction for contralateral breast cancer optional AI may also be considered in menopausal women 乳癌診療指引附註 :
2 共識 -2 ER/PR/Her-2 T 0.5cm No H/T 2 診斷 主要治療 賀爾蒙接受體 腫瘤大小 輔助治療 T 0.5cm Hormonal therapy ER( )and/or HBsAg PR( )or unknown 1. Hormonal Anti-HCV test optional 0.5 T 1.0 cm therapy C/T 2. Her-2( ) X Partial mastectomy 1 T 2.0 cm Consider 臨床檢查 R/T* Stage IA T1N0M0 Stage IB T1N1miM0 optional optional optional optional optional Total mastectomy Reconstruction ER( ) and PR ( ) 0.5 T 1.0 cm 1 T 2.0 cm 附註 : 依 NCCN-2013.V2 版建議 Stage I 臨床檢查加入考量生殖需求 4. * Herceptin 依健保使用規定或自費使用 5. 考慮接受化學治療或 Carrier 血液檢查 ( 需包含化療前 HBsAg 及 Anti-HCV test) 1. C/T 2. Her-2( ) Consider 追蹤 3 / ~ ~ X 4-5 / X 乳癌診療指引
3 共識 -3 3 X Partial mastectomy Stage IIA ALND or SLNB R/T* ER and/or T0 N1 M0 Total mastectomy PR or unknown T1 N1 M0 ALND or SLNB 臨床檢查 T2 N0 M0 reconstruction R/T* ER and PR ER/PR/Her-2 診斷 主要治療 賀爾蒙接受體 輔助治療 1. C/T H/T 2. Her-2 HBsAg Consider Anti-HCV test optional Stage IIB T2 N1 M0 optional T3 N0 M0 optional optional optional optional *MRM->R/T 1. Tumor > 5cm 2. LN positive 4 3. LN 1-3 strong consider optional 4. Margin positive 附註 : 依 NCCN-2013.V2 版建議 Stage II 臨床檢查加入考量生殖需求 4. * Herceptin 依健保使用規定或自費使用 5. RT*: 參閱一校三院放腫指引 6. 考慮接受化學治療或 Carrier 血液檢查 ( 需包含化療前 HBsAg 及 Anti-HCV test) 1. Chemotherapy 2. Her-2 Consider 追蹤 3 / ~ ~ X optional 4-5 / X (optional) 乳癌診療指引
4 共識 -4 Stage IIIA T0N2M0 T1N2M0 T2N2M0 T3N1M0 Stage IIIB T4N0M0 T4N1M0 T4N2M0 Stage IIIC Any TN3M0 臨床檢查 HBsAg Anti-HCV test X ER/PR/Her-2 (Alternative) Alternative PET scan optional 主要治療 Neoadjuvant therapy Neoadjuvant C/ T Target therapy and/or ER( )and/or PR( )or unknown Partial mastectomy R/T* Total mastectomy Reconstruction ER( ) and PR( ) 附註 : 4. RT*: 參閱一校三院放腫指引 5. Abdomen sono or abdomen CT Alternative 1. C/T H/T 2. Her-2( ) Concider Herceptin (LN negative) 1. C/T 2. Her-2 ( ) Concider Herceptin (LN negative) 斷賀爾蒙接受體 診 4 輔助治療 追蹤 3 / ~ ~ X 4-5 / X 乳癌診療指引
5 共識 -5 診斷 Stage IV Stage IV Any T Any N M1 臨床檢查 HBsAg Anti-HCV test X ER/PR/Her-2 Alternative Alternative PET scan optional Systemic chemotherapy Hormonal therapy Radiotherapy Her-2( ) >Herceptin Best supportive care Palliative surgery and other forms local treatment if needs 附註 : 4. Abdomen sono or abdomen CT Alternative 追蹤 3 / ~ ~ X 主要治療 5 (optional) 4-5 / X (optional) 乳癌診療指引
6 考文獻 1. NCCN Clinical Practice in Oncology:Breast Cancer V Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, CA CancerJ Clin 2010;60: Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365: Edge SB, Byrd DR, Compton CC, et al., eds. AJCC Cancer Staging Manual, 7th Edition. New York: Springer; Allred DC, Carlson RW, Berry DA, et al. NCCN Task Force Report:Estrogen Receptor and Progesterone Receptor Testing in Breast Cancer by Immunohistochemistry. J Natl Compr Canc Netw 2009;7 Suppl 6: Dybdal N, Leiberman G, Anderson S, et al. Determination of HER2 gene amplification by fluorescence in situ hybridization and concordance with the clinical trials immunohistochemical assay in women with metastatic breast cancer evaluated for treatment with trastuzumab. Breast Cancer Res Treat 2005;93: Chuba PJ, Hamre MR, Yap J, et al. Bilateral risk for subsequent breast cancer after lobular carcinoma-in-situ: analysis of surveillance, epidemiology, and end results data. J Clin Oncol 2005;23: Anderson BO, Calhoun KE, Rosen EL. Evolving concepts in the management of lobular neoplasia. J Natl Compr Canc Netw 2006;4: Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005;97: Vargas C, Kestin L, Go N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys 2005;63: 乳癌診療指引 參
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