妊娠期乳腺癌的治疗进展

妊娠期乳腺癌是一种特殊类型的乳腺癌。妊娠对乳腺癌的生物学行为可能的影响及诊疗措施对胎儿的影响,使得妊娠期乳腺癌的临床表现、诊断和治疗等有其特殊性。由于妊娠相关的乳腺的生理改变,妊娠期乳腺癌的诊断极具挑战性,导致诊断延误非常普遍。妊娠期乳腺癌患者的治疗策略需要多学科专家一起参与决定,在考虑胎儿安全性的同时尽量与非妊娠乳腺癌患者的标准治疗一致。妊娠期间都可以安全的行乳腺手术。妊娠第一孕期和第二孕期早期可以考虑放疗,但要注意检测胎儿暴露的放射剂量。研究证据越来越支持14孕周后可以安全的行化疗。曲妥单抗和他莫昔芬有潜在的胎儿毒性,不推荐用于妊娠期患者。

The Treatment Progress of Breast Cancer during Pregnancy

Breast cancer during pregnancy is a special kind of breast cancer. The clinical feature, diagnosis and treatment of breast cancer during pregnancy are special because of the effect of pregnancy on biological behavior and the impact of diagnosis and treatment strategy on fetal. The diagnosis of PABC is very challenging due to pregnancy associated physiological changes, which leads to common diagnosis delay. The effective treatment of breast cancer during pregnancy is possible and the termination of pregnancy is not likely to improve the maternal prognosis. Therapeutic strategy should be determined by multidisciplinary discussion, which should adhere as closely as possible to standard protocols for non-pregnant patients, but also consider fetal safety. Surgery for breast cancer is safe during all trimesters of pregnancy. Radiotherapy is considerable during the first trimester and the second trimester, but should take care of the fetal exposed dose. Evidence increasingly supports safely administration of chemotherapy from 14 weeks'' gestation onwards. Tamoxifen and trastuzumab are not recommended during pregnancy for their potiental fetal toxicity.