臨床外科66巻7号

2011年07月発行

特集 術前薬物療法は乳癌手術を縮小させるか

術前ホルモン療法とセンチネルリンパ節生検

著者： 内海俊明¹ 小林尚美¹ 宮島慎介¹ 引地理浩¹ 牛窓かおり¹

所属機関： ¹藤田保健衛生大学医学部乳腺外科

ページ範囲：P.886 - P.891

【ポイント】

◆閉経後のホルモン高感受性乳癌にはアロマターゼ阻害剤による術前ホルモン療法が有用である可能性が高く，脚光を浴びている．

◆センチネルリンパ節転移陰性例に腋窩リンパ節郭清省略は標準と考えてよい．リンパ節転移少数陽性例の腋窩リンパ節郭清省略はさらなる検討が必要である．

◆術前ホルモン療法後のセンチネルリンパ節生検に関してのエビデンスはほとんどなく，個別化治療の推進のために今後，検討が必要である．

参考文献

1）Wolmark N, Wang J, Mamounas E, et al：Preoperative chemotherapy in patients with operable breast cancer：nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 30：96-102, 2001

2）Robertson JF, Ellis IO, Elston CW, et al：Mastectomy or tamoxifen as initial therapy for operable breast cancer in elderly patients：5-year follow-up. Eur J Cancer 28A：908-910, 1992

3）Eiermann W, Paepke S, Appfelstaedt J, et al：Preoperative treatment of postmenopausal breast cancer patients with letrozole：a randomized double-blind multicenter study. Ann Oncol 12：1527-1532, 2001

4）Smith IE, Dowsett M, Ebbs SR, et al：Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination：the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen（IMPACT）multicenter double-blind randomized trial. J Clin Oncol 23：5108-5116, 2005

5）Ellis MJ, Buzdar A, Unzeitig GW, et al：ACOSOG Z1031：a randomized phase Ⅱ trial comaring exemestane, letrozole, and anastrozole in postmenopausal women with clinical stage Ⅱ/Ⅲ estrogen receptor-positive breast cancer. J Clin Oncol 28（Suppl）, 7s（abstract LBA513）

6）Semiglazov VF, Semiglazov VV, Dashyan GA, et al：Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer. Cancer 110：244-254, 2007

7）Ellis MJ, Tao Y, Luo J, et al：Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. J Natl Cancer Inst 100：1380-1388, 2008

8）Miller WR, Larionov A, Renshaw L, et al：Gene expression profiles differentiating between breast cancers clinically responsive or resistant to letrozole. J Clin Oncol 27：1382-1387, 2009

9）Krag DN, Anderson SJ, Julian TB, et al：Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer：overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 11：927-933, 2010

10）Giuliano AE, Hunt KK, Ballman KV, et al：Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis：a randomized clinical trial. JAMA 305：569-75, 2011

11）Xing Y, Foy M, Cox DD, et al：Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg 93：539-546, 2006

12）Aihara T, Munakata S, Morino H, et al：Feasibility of sentinel node biopsy for breast cancer after neoadjuvant endocrine therapy：a pilot study. J Surg Oncol 85：77-81, 2004