初诊Ⅳ期老年乳腺癌MDT诊治报道

MDT diagnosis and treatment of a stage Ⅳ elderly breast cancer patient

本文介绍1例初诊Ⅳ期老年乳腺癌病例的多学科专家组(multidisciplinary team,MDT)诊治过程。该病例初诊时78岁,右乳腺巨大肿物破溃,伴随多发骨转移、肺转移和淋巴结转移,疾病分期为Ⅳ期老年乳腺癌。经MDT讨论后患者接受紫杉醇联合卡培他滨化疗,疗效不显著,再次MDT讨论后,接受右乳腺癌改良根治术。术后行内分泌药物(来曲唑)治疗,实现疾病控制和生活质量提高。治疗10个月,疾病进展,更换内分泌治疗(氟维司群),获得长期获益。唑来膦酸治疗20个月后,患者出现左侧下颌骨病变,因无法明确是下颌骨坏死还是骨转移进展,经MDT讨论并尊重患者意愿,行姑息治疗9个月后死亡,总生存期32个月。该诊治过程说明,MDT诊治对转移性乳腺癌治疗可提供重要支持;老年乳腺癌因不同的疾病特点且缺乏前瞻性临床研究数据,尤其需要MDT模式指导治疗,全面评估风险与获益,予以个体化治疗方式。

The process of muhidisciplinary team （MDT） treatment of a stage IV elderly breast cancer patient was described. A 78-year-old woman was initially diagnosed with stage IV breast cancer with a huge ruptured mass in the right breast accompanied with multiple metastases in the bone, lung and lymph nodes. After MDT discussion, the patient re- ceived paclitaxel combined with capecitabine chemotherapy, but the disease was not controlled effectively. After a second MDT discussion, the patient received right breast modified radical mastectomy, followed by letrozole endocrine therapy. Her disease stopped progression and the quality of life was improved. However, the disease eventually progressed after 10 months. Another long time progression-free survival was obtained by changing the endocrine regimen to fulvestrant. After 20 months of zoledronic acid treatment, the patient developed left mandibular lesions, which is difficult to determine whether it is mandibular necrosis or the progression of bone metastases. After a third MDT discussion and requested by the patient, she received palliative treatment and died 9 months after, with an overall survival of 32 months. The MDT treatment process suggested that MDT provide significant supports to metastatic breast cancer, especially for elderly breast cancer, which lack prospective clinical study data because of the disease diversities. MDT discussion can provide personal treatment to patients through more comprehensive estimations for the risk and benefits.