肿瘤的多学科综合治疗.ppt

专家组讨论实例：乳腺癌专家组成员外科、内科、放射治疗科诊断活检类型：针吸、切开肿瘤标志物家族史遗传咨询或试验患者47岁女性，右乳外上象限5厘米肿块分期IIIA期乳腺癌要行转移灶排除检查专家组讨论实例：乳腺癌(续)供考虑的联合治疗全身性：术前或术后乳房切除术：全部或部分乳房重建：同时或延迟，活瓣或灌注前哨淋巴结活检；？如前哨淋巴结阴性，是否行完全性腋下淋巴结清扫放疗后化疗或反之?内分泌治疗：药物及期限长期随访全身治疗：新辅助化疗新辅助化疗后PhotographscourtesyofDanielBooserandHenryKuerer.新辅助化疗前其他全身治疗选择：新辅助内分泌治疗治疗前来曲唑治疗三个月后外科选择期病变乳房切除后同时皮瓣重建外科选择：保乳治疗PhotographscourtesyofFrankieHolmes.新辅助治疗后，乳房肿瘤切除及放疗后新辅助治疗前不同外科选择的最终结果乳腺癌实例总结局部晚期乳腺癌的最佳治疗需要多种手段新辅助化疗增加保乳手术的切除率，并对可选择病人的外科保乳成为可能不同的同时乳房重建术应尊重正接受乳房全切术患者的意愿对治疗无效或疾病进展的患者应给全身性的非交叉耐药治疗多学科治疗讨论会:软组织肉瘤实例患者患有巨大的，高度恶性的大腿深部滑膜肉瘤推荐行髋关节离断术肿瘤从活检部位长出肿瘤多学科规范治疗教程MultidisciplinaryCancerManagerCourse,MCMC肿瘤多学科规范治疗教程MultidisciplinaryCancerManagerCourse,MCMCThismodulefocusesontheimportanceofcorrectdiagnosisandaccuratestagingofdisease,developingamultidisciplinarytreatmentplan,andprovideskeypointsaboutclinicaltrials.Attitudeiscriticalcomponent.MultidisciplinaryconferenceisequivalenttoaTumorBoard.GreeneFL,PageDL,FlemingID,etal(eds).AJCCCancerStagingManual,

6thed,NewYork,NY:Springer;2002.Neoadjuvanttherapyallowsfortumordownstagingsuchthatinoperablediseasebecomesoperable.Themarkedeffectachievedbythreemonthsoftreatmentwithletrozoleforapostmenopausalwomanwithestrogen-receptorpositivebreastcancer.MillerWR,IngleJN.EndocrineTherapyinBreastCancer.NewYork,NY:MarcelDekker,Inc.;2002.{Author:Creditlineneededforphotoifprovidedbyanotherphysician.}Forselectedpatientswithmarkedreductioninthesizeoftheprimarytumoraftertheuseofneoadjuvanttherapy,breast-conservingsurgerymaybepossible(onlymastectomywouldhavebeenpossiblepriortochemotherapy).Insummary,theoptimalcareofpatientswithlargeprimaryandlocallyadvancedbreastcancerrequiresamultimodalityapproachtotherapy,consistingofaccuratediagnosisandstaging,systemictherapy,surgery,complete