a******2
发帖数: 143 | 1 我妈妈65岁，在国内，3周前查出乳腺癌，做了手术，现在要开始术后治疗了，医生初
步决定6-8期化疗加放疗再加一年靶向。我们很担心术后治疗的副作用，如果没必要，
不想过度治疗把我妈妈身体弄坏。我妈妈病理如下，请专家帮着看看这治疗方案好不好
？另外，美国有什么好的保健品给化疗的病人吗？非常感谢！！！
医院1的病理：
右乳肿块挖除后切口周围腺病
腋窝淋巴结查及23枚，未见癌转移
（部分II区），淋巴结1枚，未见癌转移
（部分腋窝）淋巴结2枚，未见癌转移
（腋窝外侧）淋巴结3枚，未见癌转移
乳头乳晕区未见癌侵袭
右乳-部分为导管内癌，部分为浸润性导管癌，少数为粘液癌，总体积6X3X3CM。
ER（+）、Ki-67(5%+),PR(-), CerbB(+++)
医院2的病理：
>30%的浸润性肿瘤细胞呈强且完整的包膜着色
雌性素受体（ER- ）阳性细胞约占75%，平均着色强度：中等
乳腺浸润性导管癌2级伴粘液癌（约占15%）
ER70%，PR15%，Her-2(3+),Ki-67 50%, P53 55% | yf
发帖数: 272 | 2 Your mother has stage IIIA(T3N0M0) ER positive/PR positive/HER2 positive
Invasive ductal carcinoma. There is discrepancy regarding the PR status and
Ki 67 percentage. Ki 67 is usually not so reliable. PR status is considered
positive in the second hospital pathology but negative in the first hospital
pathology. Anyway the cancer is high risk, your mother needs chemotherapy,
radiation therapy, 1 year of trastuzumab(Herceptin), and at least 5 years of
aromatase inhibitor. Every part of the treatment plan decrease recurrence
risk. Heart function needs to be monitored every 3-6 months by MUGA scan
during trastuzumab treatment. You need to listen to the doctors. If there is
any contraindications to treatment , you need to talk to the doctor. There
are a lot of side effects but the biggest risk now if the cancer recurrence
and metastasis. Your mother has a BIG cancer and high risky cancer which is
treatable, don't play with it. | yf
发帖数: 272 | 3 And never never believe in any BAO JIAN PING. | f********t
发帖数: 27 | 4 一些在美国行医的中国癌症医生组织了一个网站，为国内的患者提供Second Opinion.
不妨试试,看有没有好的治疗方案。
www.ChineseCancer.net | a******2
发帖数: 143 | 5 太感谢大家的建议了， 上网不方便，没能及时谢谢大家，抱歉！
没敢耽误，我妈在天津肿瘤医院开始化疗了，ACX4 +THX4，标准药，昨天作了第一次化
疗。现在的问题是医院要我妈每2星期化疗一次，我妈病房里的病友也是2星期化疗一次
， 查资料AC标准治疗是每3星期化疗一次，所以又担心了，我妈都65了，怕对她身体损
害太大，大家看有必要这么密集吗？问医生医生说他们的方案就是觉得对病人好的方案
。 以下是我妈第一次化疗的用药量， 请大家看看这是不是过度治疗啊，如果是，想着
不行就转院，就是太折腾老妈了，但如果没必要不想太伤我妈身体，天津的医生也不会
按病人的要求改他们的方案的。
Doxorubicin：total 140mg （分2天输的）
cyclophosphami: total 800mg
我妈体重：70公斤 身高：160米 | yf
发帖数: 272 | 6 I guess they used dose dense AC, so it's every two weeks protocol and it's
standard. Neulasta is a must for dose dense AC, or neupogen. AC is Q 3wks,
the dose is different from dose dense AC. But dose dense AC is a little
more effective than AC and is the standard now.
The doctors in Tianjing are doing the right thing.
If your mother has weak heart which is proven by ECHO or MUGA scan, then you
can consider TCH(Docetaxel (Taxotere) 75 mg/m2 iv d1 q3w x 6 cycles
Carboplatin (Paraplatin) AUC 6 iv d1 q3w x 6 cycles
Trastuzumab (Herceptin) 4 mg/kg loading dose followed by 2 mg/kg iv qw
during chemotherapy; then 6 mg/kg iv q3w，for a total of 1 year
according to BCIRG -006 trial. | yf
发帖数: 272 | 7 Whether to use anthracycline(doxorubicin is one of them) or not is a never
ending discussion. I am trained in east-coast, so I like anthracycline, but
people in mid-west or west coast like TCH. No right or wrong. | a******2
发帖数: 143 | 8 太谢谢你了，看到2星期也是标准治疗感觉好了很多。你说dose for 3 weeks is
different from that for 2 weeks 吗？ 是多还是少？我算了一下， 我妈表面积大约
是1.7平米，60mg/m^2 x 1.7m^2 应该是102mg AC,可大夫给我妈输了140mg, 是不是多
太多了？我们正想着去北京的医院问问呢
you
【在 yf 的大作中提到】
: I guess they used dose dense AC, so it's every two weeks protocol and it's
: standard. Neulasta is a must for dose dense AC, or neupogen. AC is Q 3wks,
: the dose is different from dose dense AC. But dose dense AC is a little
: more effective than AC and is the standard now.
: The doctors in Tianjing are doing the right thing.
: If your mother has weak heart which is proven by ECHO or MUGA scan, then you
: can consider TCH(Docetaxel (Taxotere) 75 mg/m2 iv d1 q3w x 6 cycles
: Carboplatin (Paraplatin) AUC 6 iv d1 q3w x 6 cycles
: Trastuzumab (Herceptin) 4 mg/kg loading dose followed by 2 mg/kg iv qw
: during chemotherapy; then 6 mg/kg iv q3w，for a total of 1 year
| yf
发帖数: 272 | 9 What I meant was the dose divided by days is different. That's why one is
called dose DENSE. Because you give the dose in less time. But you need to
give nebula sat for blood cell support. Google Citron 2003 paper.
I don't know why doxorubicin was given 140mg. Your mom's BSA is 1.7, 60x1.7
=102
By the way, your mom is overweight. BMI is 27. | a******2
发帖数: 143 | 10 谢谢你的回复，大夫是给开了增白剂津优力3mg，说是最好的，明天去打，但没要我妈
验血说直接打，这种药不需验白细胞量就打吗？另外我妈AC给输了140mg但分了2天，一
天70mg,是不是因为分2天输所以量可以大些呢？
太感谢你的回复了，国内大夫不像这里给解释清楚，问也不给多说，有时真有点儿不知
如何是好了，今天我妹去北京医院想问问2nd opinion,买了黄牛挂号票，结果因为病理
是天津的不是北京那个医院的，那个著名的大夫拒绝给任何建议，真是无奈！
to
.7
【在 yf 的大作中提到】
: What I meant was the dose divided by days is different. That's why one is
: called dose DENSE. Because you give the dose in less time. But you need to
: give nebula sat for blood cell support. Google Citron 2003 paper.
: I don't know why doxorubicin was given 140mg. Your mom's BSA is 1.7, 60x1.7
: =102
: By the way, your mom is overweight. BMI is 27.
| yf
发帖数: 272 | 11 Yes, give neupogen or neualsta prophylactically, no need to check CBC. ZHI
JIE DA. Sorry I cannot input Chinese.
I really don't know about the doxorubicin business. Theoretically, it should
be 102 mg in one day. Why 140mg in two days? I am not sure.
We recommend limiting lifetime cumulative dose to <550 mg/m2 to reduce risk
of cardiotoxicity. Your mother's dose is 140mgx4=560mg, while 550mg/m2x1.7
m2=935mg. 560mg is less than 935mg. She should still be fine.
Here is a paper by Dr. Swain in 2003 calling precaution of doxorubicin in
older patient, for your reference.
Cancer. 2003 Jun 1;97(11):2869-79.
Congestive heart failure in patients treated with doxorubicin: a
retrospective analysis of three trials.
Swain SM1, Whaley FS, Ewer MS.
Author information
Abstract
BACKGROUND:
Doxorubicin is a highly effective and widely used cytotoxic agent with
application that is limited by cardiotoxicity related to the cumulative dose
of the drug. A large-scale study that retrospectively evaluated the
cardiotoxicity of doxorubicin reported that an estimated 7% of patients
developed doxorubicin-related congestive heart failure (CHF) after a
cumulative dose of 550 mg/m(2). To assess whether this estimate is
reflective of the incidence in the broader clinical oncology setting, the
authors evaluated data from three prospective studies to determine both the
incidence of doxorubicin-related CHF and the accumulated dose of doxorubicin
at which CHF occurs.
METHODS:
A group of 630 patients who were randomized to a doxorubicin-plus-placebo
arm of three Phase III studies, two studies in patients with breast
carcinoma and one study in patients with small cell lung carcinoma, were
included in the analysis.
RESULTS:
Thirty-two of 630 patients had a diagnosis of CHF. Analysis indicated that
an estimated cumulative 26% of patients would experience doxorubicin-related
CHF at a cumulative dose of 550 mg/m(2). Age appeared to be an important
risk factor for doxorubicin-related CHF after a cumulative dose of 400 mg/m(
2), with older patients (age > 65 years) showing a greater incidence of CHF
compared with younger patients (age < or = 65 years). In addition, > 50% of
the patients who experienced doxorubicin-related CHF had a reduction < 30%
in left ventricular ejection fraction (LVEF) while they were on study.
CONCLUSIONS:
Doxorubicin-related CHF occurs with greater frequency and at a lower
cumulative dose than previously reported. These findings further indicate
that LVEF is not an accurate predictor of CHF in patients who receive
doxorubicin.
Copyright 2003 American Cancer Society. | F********1
发帖数: 151 | | M**1
发帖数: 327 | |
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