แนวทางการรักษาเสริมด้วยยา (Treatment guidelines)
แนวทางการรักษาเสริมนั้น ได้แสดงไว้ในตารางที่ 2 และตาม Consensus Panel Recommendations, St. Gallen Cenferences 1992, 19958
ตารางที่ 2 การรักษาเสริมในผู้ป่วย negative lymph node
| Lymphnode negative patients | ||
|
Minimal/low risk Size < 1 cm And R+ And Grade 1 And Age > 35 yrs. Including: Non-invasive DCIS Tumors < 1 cm detected By screening Mammography No routine Adjuvant therapy TAM |
Good risk Size 1 - 2 cm R+ Grade 1 2
TAM In premenopausal R+ : Oophorectomy CTX GnRH analogue |
High risk Size > 2 cm Or R- Or Grade 2 3
Adjuvant therapy According to the Guidelines for N+ patients |
Abbreviations:
N- node-negative disease
N+ node-positive disease
R- estrogen/progesterone receptor-negative
R+ estrogen/progesterone receptor-positive
DCIS ductal carcinoma in situ
CTX polychomotherapy
OA ovarian ablation
TAM tamoxifen; PBSC, peripheral blood stem cell support
ABMT autologous bone marrow transplantation
Guidelines for adjuvant therapy of node-negative operable breast cancer, according to the Consensus Panel recommendations drawn up at the 1992 and 1995 St. Gallen Conferences.
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ตารางที่ 3 การรักษาเสริมในผู้ป่วย positive lymph node
< 10 Nodes > 10 Nodes Elderly (> 70 years)
Premenopausal Postmenopausal R+ R- R+ R- R+ R-CTX CTX TAM CTX Intensified TAM CTX
or OA TAM+CTX CTX + TAM CTX (if tolerated)CTX+TAM then CTX + TAM
CTX+OA Consider1 :
A+TAM TAM in R+
GnPH analogue High-dose CTX
+ PBSC or ABMT
Abbreviations:
N- node-negative disease CTX polychomotherapy
N+ node-positive disease OA ovarian ablation
R- estrogen/progesterone receptor-negative TAM tamoxifen
R+ estrogen/progesterone receptor-positive PBSC peripheral blood stem cell support
DCIS ductal carcinoma in situ ABMT autologous bone marrow transplantation
Italics indicate that the adjuvant treatment option thus marked is still investigational