乳癌治療之演進

The Evolution of Breast Cancer Treatment

謝德熾(Te-Chi Hsieh) ； 陳立奇(Lih-Chi Chen)

《北市醫學雜誌》 7卷3期 (2010/09) Pp. 313-322

https://doi.org/10.6200/TCMJ.2010.7.3.14

摘要

乳癌是個有古老歷史的疾病，西元前2500年The Edwin Smith Surgical Papyrus已記錄了8個乳癌治療的案例，而至今乳癌仍是重要的健康和醫療問題。乳癌真正可靠的治療始於19世紀晚期的外科手術，早期的外科治療往擴張切除病灶的方向發展，但到了20世紀中期，放射線的治療成功提高了乳癌局部控制率，使乳房保留手術成為主要的選擇。至20世紀70年代全身性輔助治療，如化療、賀爾蒙治療等的成功發展，不僅大幅提高了乳癌的存活率，同時也改變了人類對乳癌生物學的認識。20世紀晚期發展的分子醫學，除了讓乳癌的研究有了全新的觀點，也引領了標靶治療時代的來臨，並讓未來乳癌的治療朝向個人化發展。現在全世界對乳癌診療已有可靠的診療指引可供依循，回顧過去，今日的診療指引和各種治療方法的出現，都是前人不斷地努力所換得的珍貴成果。

關鍵字

乳癌 ； 治療演進 ； 診療指引

並列摘要

Breast cancer is a disease that has an ancient history as has been established by the fact that, in 2500 BC, the Edwin Smith Surgical Papyrus documents eight cases of breast cancer. Breast cancer is still an important health and medical issue today. Surgery was the first reliable tool used to treat breast cancer. This approach was initiated after important progress occurred towards the end of 19th century and has lead to the development of present day treatment and theory. Surgical margins became more and more extended during the early decades of treatment until mature radiotherapy was developed towards the middle of the 20th century. The surgery/radiotherapy combination made breast-conserving surgery the first choice because it had a similar locoregional control rate. The success of chemotherapy and hormone therapy from the 1970s onwards not only improved survival, but also changed our understanding of the biology of breast cancer. In the late 20th century, molecular medicine began to provide a new point of view when studying breast cancer, and the era of targeted therapy had arrived. The treatment of breast cancer will become personalized in the future. Using this history review, we would emphasize the contributions made by many people and their long period hard work to establish reliable guidelines for treating breast cancer treatment in clinical practice.

並列關鍵字

breast cancer ； evolution of treatment ； therapeutic guidelines