200808300913Inflammatory Breast Cancer 發炎性乳癌?乳癌研究 Inflammatory Breast Cancer (IBC) 發炎性乳癌 發炎性乳癌：一種少見的乳癌類型(約所有乳癌的2%)，其癌細胞會阻塞乳房皮膚內的淋巴管。因此乳房會變紅、腫脹、溫暖且乳房皮膚可能有凹痕或皺折。 2008 ASCO 年會, Tulane school of public health報告, SEER program, IBC 發炎性乳癌發生率約0.3-0.7 per 100,000 person , IBC有17.3% distant metastasis 遠端轉移(所以很多美國醫院, 對懷疑IBC的病人做正子電腦斷層). Lafayette University medical center 2008年報告說, MD Anderson Dr. Cristofanilli 有約240個IBC病例, 30%為賀爾蒙接受體陽性. MD Anderson reported chemotherapy first (neoadjuvant) , then surgery, then radiotherapy for inflammatory breast cancer. 根據統計，乳癌病患如腋下淋巴腺轉移數目在十顆以上，以及局部侵犯嚴重(locally advanced) 之第三期乳癌患者，或是發炎性乳癌(stage IIIB)患者，即使在接受標準的手術前化學治療 (neoadjuvant chemotherapy)、乳房切除手術以及術後的放射線治療加上輔助性化學治療後，其五年無病存活率亦不到百分之五十。根據City of Hope醫學中心統計，發炎性乳癌患者於治療後追蹤三年及五年，其無病存活率分別只有29%及17%。因此有學者提出以高劑量化學治療合併骨髓或周邊血液幹細胞移植用來治療高危險群乳癌病患的構想。 於1993年Duke醫學中心以及CALGB發表85位乳癌病患，其腋下淋巴腺轉移數目均在十顆以上，以及局部侵犯嚴重之第三期乳癌患者，在接受標準的手術以及輔助性化學治療(CAF)後，以高劑量之Carmustine, CDDP以及Endoxan化學治療輔以自體骨髓或周邊血液幹細胞移植。其追蹤兩年半的無病存活率及總存活率分別為72%及79%，因治療而引起的死亡率為12%。於1995年該作者又發表其追蹤五年的結果，無病存活率及總存活率與兩年半時作比較並無太大改變。 City of Hope醫學中心，研究114位乳癌病患，其腋下淋巴腺轉移數目均在十顆以上，或是局部侵犯嚴重(locally advanced)之第三期乳癌患者，或是發炎性乳癌(stage IIIB)患者，在接受標準的手術以及輔助性化學治療後，以高劑量之Etoposide, Endoxan以及Doxorubicin 或Cisplatin化學治療輔以周邊血液幹細胞移植。追蹤46個月的無病存活率於第II,IIIA,IIIB期病患分別為71%,57%及50%，其總存活率則分別為82%,79%及72%。於單變數分析(Univariate analysis) 中，發現病患如其progesterone接受體為陽性者，其復發率較低(P=0.01)。如為發炎性乳癌則復發率較高(P=0.05)。病患如estrogen或progesterone接受體為陽性者，其總存活率較高(P=0.05 & 0.003) 。病患如腫瘤組織形態為高惡性度者者，其總存活率較低(P=0.02)。於多變數分析(Multivariate analysis) 中發現病患如progesterone接受體為陽性者，其無病存活率較高(P=0.001)。 Lapatinib for refractory IBC (refractory to anthracyclines, taxanes, herceptin), is likely to reponse in HER2/HER3 pathway patients. Future trial for IBC : ATX, EN, cTCH, nab-TCH. Research Shows PET/CT Spots Spread of Inflammatory Breast Cancer Earlier M. D. Anderson News Release 11/30/07 The spread of an extremely aggressive form of breast cancer can be detected earlier by using a combination of two imaging modes, researchers at The University of Texas M. D. Anderson Cancer Center reported at the Radiological Society of North America annual meeting. Combining computed tomography (CT) with positron emission tomography (PET) enables researchers to more quickly and accurately pinpoint the location of metastases from inflammatory breast cancer. About 40 percent of women with the disease survive for five years. "Our results showed that PET/CT allows non-invasive evaluation and accurate cancer staging throughout the body in a single examination," says Selin Carkaci, M.D., assistant professor in M. D. Anderson's Department of Diagnostic Radiology, who presented the research at the meeting. "PET/CT is able to detect disease in its earliest stages, when changes are happening at a functional and cellular level, which is quite different from other imaging modalities that identify disease when there is distortion of normal anatomy," Carkaci says. Early identification of metastases allows earlier treatment. The study presented in Chicago included 41 women newly diagnosed with inflammatory breast cancer who each underwent a whole-body PET/CT exam. Metastases were found in 20 patients (49 percent) and were confirmed by biopsy or correlative imaging. Two false positives identified disease when none was present, resulting in an accuracy rate of 95 percent. PET/CT scans were 98 percent accurate in identifying cancer that had spread to the local lymph nodes. Currently CT, whole body bone scan, ultrasound and MRI are most often used imaging modalities for detecting disease spread to distant sites. FDG PET/CT has an emerging role in the comprehensive staging of inflammatory breast cancer. CT provides a detailed image of the body's organs, bones, other tissues and tumors. PET reflects what the tumors are doing - metabolically and chemically. A patient receiving a PET/CT, is first injected with a radioactive drug consisting of F-18 tagged glucose. The CT scanner takes a series of x-ray pictures to create an extremely detailed image of the size and shape of the abnormal cancerous growths. A PET scan then detects where the glucose has gathered, literally lighting up areas of concentration. Because fast-growing tumors more readily absorb glucose than normal cells, they show up as bright spots on the PET scan that tip off their location and concentration in the affected organs. Some recent studies showed that the use of PET/CT early in the course of the systemic therapy could quickly determine whether a treatment regimen is working or should be changed. Whether or not PET/CT should become the clinical standard for evaluation of response to therapy awaits more research. "Large-scale trials addressing the clinical utility of PET/CT may lead to a change in the routine diagnostic algorithm and follow-up protocols for patients with inflammatory breast cancer," Carkaci says. Inflammatory breast cancer is rare - representing just 1-5 percent of all breast cancers diagnosed. Unlike other breast cancers that present as a lump, inflammatory breast cancer is a more diffuse disease that spreads throughout the breast tissue. Symptoms include: redness, swelling, and warmth in the breast, skin that is reddish, purple or bruised, has ridges and/or appears pitted like an orange. Because the symptoms are ambiguous, women with IBC are more likely than other women with breast cancer to be misdiagnosed, and ultimately diagnosed after the disease has metastasized. Earlier this year, M. D. Anderson opened the world's first clinic devoted to treating the disease, the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic. The clinic sees more cases of inflammatory breast cancer than any institution in the United States. Co-authors with Carkaci are senior author Homer A. Macapinlac, M.D., chair of M. D. Anderson's Department of Nuclear Medicine; H.T. Le-Petross, M.D., of M. D. Anderson's Department of Diagnostic Radiology; Massimo Cristofanilli, M.D., of M. D. Anderson's Department of Breast Medical Oncology and director of the Welch Clinic; and A. M. Angullo-Gonzalez, M.D., of M. D. Anderson's Department of Breast Medical Oncology and W.T. Yang, M.D., of M. D. Anderson's Department of Diagnostic Radiology, Chief of Breast Imaging Section.
American Cancer Society CMO Discusses IBC Treatment.The CNN (6/1) "The Chart" blog, Dr. Otis Brawley, chief medical officer at the American Cancer Society, answers a viewer's question about treatment for inflammatory breast cancer. Dr. Brawley wrote, "Therapy of IBC confined to the breast and armpit is usually chemotherapy followed by surgery to remove the breast (a mastectomy) and lymph nodes of the armpit, then radiation to the chest wall and armpit." Dr. Brawley wrote that "breast conserving therapy is rarely possible. After treatment that leads to disappearance of disease, the patient should undergo good surveillance to detect recurrence early." For patients that experience a relapse, the standard treatment is chemotherapy and radiation. Unfortunately, he wrote, "this is a disease in which our therapies are far from adequate."
References: 1. 彰化醫學中心乳癌衛教手冊 2. 王緯書醫師, High-dose chemotherapy and stem-cell rescue in the treatment of high-risk breast cancer: prognostic indicators of progression-free and overall survival (J Clin Oncol 1997:15;2882-2893) 3. http://www.ibcresearch.org/ 4. http://www.youngsurvival.org/young-women-and-bc/bc-faqs/inflammatory-breast-disease/ 5. http://www.mdanderson.org/diseases/breastcancer/display.cfm?id=39c2c5ae-a411-49e9-875855cb37b6c999&method=displayfull |
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