Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press127410.17650/1994-4098-2024-20-3-31-43MAMMOLOGY. REVIEWSМАММОЛОГИЯ. ОБЗОРНЫЕ СТАТЬИThe role of local and systemic control methods in the treatment of oligometastatic breast cancer, taking into account biological subtypes (literature review)Роль локальных и системных методов контроля в лечении олигометастатического рака молочной железы с учетом биологических подтипов опухоли (обзор литературы)https://orcid.org/0000-0002-0398-790XSevostyanovaT. I.СевостьяноваТ. И.
Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-4305-6691SemiglazovaT. Yu.СемиглазоваТ. Ю.
Russian Federation

Tatyana Yuryevna Semiglazova

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758; 41 Kirochnaya St., Saint Petersburg 191015

Татьяна Юрьевна Семиглазова

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68; 197022 Санкт-Петербург, ул. Льва Толстого, 6—8

tsemiglazova@mail.ruhttps://orcid.org/0009-0005-1517-8228PonasenkoO. I.ПонасенкоО. И.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0009-0005-7141-6286LyaschenkoV. A.ЛященкоВ. А.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-6601-2528AbdullaevaSh. R.АбдуллаеваШ. Р.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-0728-4582FilatovaL. V.ФилатоваЛ. В.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-9189-6417BryantsevaZh. V.БрянцеваЖ. В.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0003-3844-2085KasparovB. S.КаспаровБ. С.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-0871-9453PaltuevR. M.ПалтуевР. М.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-8825-5221SemiglazovV. V.СемиглазовВ. В.
Russian Federation

68 Leningradskaya St., Pesochnyy Settlement, Saint Petersburg 197758; 6—8Lva Tolstogo St., Saint Petersburg 197022

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-4898-9159KrivorotkoP. V.КриворотькоП. В.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0002-7185-1967NovikovS. N.НовиковС. Н.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

https://orcid.org/0000-0003-0077-9619SemiglazovV. F.СемиглазовВ. Ф.
Russian Federation

197758 Санкт-Петербург, пос. Песочный, ул. Ленинградская, 68

N.N. Petrov National Medical Research Oncology Center, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова» Минздрава РоссииN.N. Petrov National Medical Research Oncology Center, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Петрова» Минздрава РоссииMechnikov North-Western State Medical University, Ministry of Health of RussiaФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииPavlov First Saint Petersburg State Medical University, Ministry of Health of RussiaФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России0911202420331430811202408112024https://ojrs.abvpress.ru/ojrs/article/view/1274

Combined methods of treatment of oligometastatic breast cancer (OMBC) based on systemic drug treatment and local treatment methods - stereotactic radiation therapy (SRT) or surgical treatment - are not included in current clinical guidelines. The European Society of Medical Oncology (ESMO) recommends the use of local control methods for patients with breast cancer without taking into account the biological subtype of the tumor. This review presents a modern understanding of the oligometastatic biological subtype based on data from clinical studies on this topic, which could contribute to decision-making in real clinical practice.

The aim of the review is analysis of the effectiveness of combined treatment methods: systemic drug therapy and local treatment methods (SRT) or surgical treatment of breast cancer of various molecular genetic subtypes.

To assess the clinical effectiveness of various approaches to the treatment of breast cancer, depending on the biological subtype, a search was conducted for scientific publications in the Medline bibliographic database. Prospective and retrospective studies demonstrate an increase in the effectiveness of treatment through a combination of systemic therapy and local control methods (surgical treatment or SRT) OMBC depending on the biological subtypes. In hormonepositive breast cancer with bone damage, SRT is most preferable, whereas in visceral oligometastases, surgical treatment is recommended. For immunocompetent tumors of triple-negative and HER2-positive biological subtypes of breast cancer, surgical treatment of OMBC is not recommended, except in cases where the positive status of HER2 is combined with a high level of expression of hormonal receptors or metastatic bone damage.

The results of current prospective studies focusing on certain biological subtypes of breast cancer will help further determine the role of this strategy in the treatment of this cohort of patients. Understanding the characteristics of the tumor process in breast cancer will allow you to personalize the treatment of patients with this disease.

Комбинированные методы терапии олигометастатического рака молочной железы (ОМРМЖ) на основе системного лекарственного лечения и локальных методов лечения - стереотаксической лучевой терапии (СТЛТ) или хирургического лечения - не включены в действующие клинические рекомендации. Европейское общество медицинской онкологии (ESMO) рекомендует использование методов локального контроля для больных ОМРМЖ без учета биологического подтипа опухоли. В данном обзоре представлено современное понимание олигометастатического биологического подтипа на основе данных клинических исследований по этой теме, которое могло бы способствовать в принятии решений в реальной клинической практике.

Цель обзора - анализ эффективности комбинированных методов лечения: системной лекарственной терапии и локальных методов лечения (СТЛТ) или хирургического лечения ОМРМЖ различных молекулярно-генетических подтипов.

Для оценки клинической эффективности различных подходов к лечению ОМРМЖ в зависимости от биологического подтипа опухоли был проведен поиск научных публикаций в библиографической базе данных Medline. Проспективные и ретроспективные исследования демонстрируют повышение эффективности лечения путем комбинации системной терапии и методов локального контроля (хирургическое лечение или СТЛТ) ОМРМЖ в зависимости от биологического подтипа опухоли. При гормоноположительном ОМРМЖ с поражением костей наиболее предпочтительно проведение СТЛТ, тогда как при висцеральных олигометастазах - хирургическое лечение. Для иммунокомпетентных опухолей трижды негативного и HER2-положительного (HER2+) биологических подтипов рака молочной железы хирургическое лечение олигометастатического биологического подтипа не рекомендуется, за исключением случаев, когда положительный статус HER2 сочетается с высоким уровнем экспрессии гормональных рецепторов или метастатическим поражением костей.

Результаты текущих проспективных исследований с акцентом на определенные биологические подтипы рака молочной железы помогут в дальнейшем определить роль этой стратегии в лечении данной когорты пациентов. Понимание биологических характеристик ОМРМЖ позволит персонализировать лечение данной категории больных.

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