长春瑞滨联合表阿霉素新辅助化疗治疗乳腺癌的临床观察

目的　评价长春瑞滨联合表阿霉素新辅助化疗治疗乳腺癌的近期疗效及副反应。方法　用长春瑞滨联合表阿霉素对Ⅱ、Ⅲ期乳腺癌 2 4例进行新辅助化疗 3～ 4周期 ,第 1天静脉注射表阿霉素 6 0mg m2 、长春瑞滨 30mg m2 ,第 8天静脉注射长春瑞滨 30mg m2 ,4周为 1周期。结果　临床有效率 (cCR PR)为 79% ,无进展病例 ,病理完全缓解率 (pCR) 12 5 %。副反应为白细胞下降、恶心呕吐、脱发、静脉炎、头痛等 ,患者均可耐受。结论　 3～ 4周期长春瑞滨联合表阿霉素新辅助化疗是治疗乳腺癌安全有效的方法。     

TEC与CEF方案在乳腺癌术前化疗中的疗效对比研究

目的评价TEC与CEF方案在乳腺癌术前化疗中的疗效和毒性反应。方法对100例术前确诊的乳腺癌患者行术前化疗,按配对分组法均分为TEC组与CEF组,3个疗程化疗后接受手术治疗,对2组患者化疗疗效和毒性反应进行对比分析。结果 CEF组中4例ⅢB期患者在化疗2个疗程后因效果不佳而退出研究。TEC组患者临床完全缓解(cCR)7例,部分缓解(cPR)34例,病情稳定(SD)9例;总缓解率(RR)为82.0%(41/50),降期率为64.0%(32/50)。CEF组患者cCR 2例,PR 32例,SD 12例,RR为68.0%(34/50),降期率为40.0%(20/50)。TEC组患者在化疗临床疗效和降期率方面明显优于CEF组,差异有统计学意义(P<0.05)。2组患者淋巴结转阴率分别为54.1%(20/37)和57.1%(20/35),差异无统计学意义(P>0.05)。脱发和白细胞减少发生率TEC组高于CEF组(P<0.05),但血小板减少、血红蛋白减少、恶心呕吐、腹泻、心脏毒性和神经毒性发生率的差异均无统计学意义(P>0.05)。结论 TEC方案在乳腺癌新辅助治疗中的疗效和安全性优于CEF方案,且耐受性好。     

新辅助化疗联合曲妥珠单抗对HER-2过表达乳腺癌的疗效观察

目的:观察新辅助化疗联合曲妥珠单抗对HER-2过表达乳腺癌的临床疗效。方法:39例HER-2过表达的乳腺癌患者,均采用多西他赛及卡铂新辅助化疗联合曲妥珠单抗治疗,6个周期后观察疗效并对乳腺癌组织中雌激素受体(ER)表达状态与病理完全缓解(pCR)率之间行单因素分析。结果:39例患者总有效率(OR)为94.9%(37/39);其中临床完全缓解(cCR)26例(66.7%),部分缓解(PR)11例(28.2%),疾病稳定(SD)2例(5.1%),无疾病进展(PD)病例。病理完全缓解(pCR)27例(69.2%)。单因素分析显示,ER阴性组的pCR率为82.4%,ER阳性组为59.1%。结论:在HER-2过表达乳腺癌的新辅助化疗中,多西他赛及卡铂联合曲妥珠单抗疗效良好,且ER受体阴性患者可获较高的缓解率。     

不同方案在乳腺癌新辅助化疗中的作用

目的：比较两组不同化疗方案DE与FEC用于局部晚期乳腺癌新辅助化疗的疗效。方法：56例Ⅲ期乳腺癌患者分为两组,DE组31例,用EPI和多西紫杉醇治疗。FEC组25例,以环磷酰胺、表阿霉素、氟尿嘧啶治疗。结果：FEC组的总有效率为60%,DE组的总有效率为83.8%。DE组有9例病理完全缓解,FEC组中有1例进展。结论：两组新辅助化疗方案对乳腺癌治疗均有效,毒性反应均可耐受。DE组疗效及毒性反应均高于FEC组。     

绝经后乳腺癌术前新辅助治疗临床应用

目的探讨绝经后乳腺癌新辅助治疗(包括术前内分泌治疗和新辅助化疗)的临床疗效及其临床意义。方法 76例经空芯针穿刺活检或病理组织学确诊的绝经后乳腺癌患者,术前激素受体阳性的予以内分泌治疗,受体阴性的予以新辅助化疗(TAC方案)。内分泌组21例,来曲唑2.5 mgqd。TAC组5 5例(紫杉醇1 5 0 mg/m2,表柔比星6 0 mg/m2,CTX 5 0 0 mg/m2,静脉滴入d1)。2～4个周期后观察肿瘤、腋窝淋巴结的变化。结果术前内分泌治疗后达到临床部分缓解(PR)10例,有效率4 7.6 2%;新辅助化疗后临床完全缓解(CR)4例,PR 3 6例,共4 0例有效,有效率为7 2.7 3%。内分泌治疗组疾病进展(PD)11例,占52.38%;腋窝淋巴结肿大者16例,PR 7例,有效率43.75%。新辅助化疗组疾病进展15例,占27.27%;腋窝淋巴结肿大者42例,临床CR 4例,PR 20例,有效率57.14%。结论绝经后新辅助治疗可有效缩小肿瘤原发病灶和腋窝淋巴结,降低肿瘤分期,增加保乳手术或手术切除的机会。     

术前新辅助化疗在局部中晚期乳腺癌中的应用附30例报道

目的: 探讨局部中晚期乳腺癌新辅助化疗的临床意义. 方法: 应用CEF方案对30例Ⅱb-Ⅲ期乳腺癌患者进行新辅助化疗. 环磷酰胺(CTX) 600 mg/m2, d1, ;表阿霉素(EPI) 60mg/m2, d1,5-氟尿嘧啶(5Fu) 500 mg/m2, d1, 21d为1个周期,所有患者完成2个周期新辅助化疗后评价疗效.结果: 21例降低了临床分期;3例获得完全缓解(CR),18例部分缓解(PR),6例病情稳定,1例无效,总有效率(CR+PR)为70%. 结论: 进展期乳腺癌新辅助化疗对原发肿瘤和腋窝淋巴结均有较好疗效.     

晚期乳腺癌新辅助化疗的临床报告

目的　探讨新辅助化疗在晚期乳腺癌治疗中的远期临床效果。方法　对 31例Ⅲ、Ⅳ期的乳腺癌患者行新辅助化疗 ,手术前行 2周期的CAF方案化疗〔CTX 5 0 0mg/m2 静脉推注 (第 1、8天 ) ,5 FU 5 0 0mg/m2 静脉推注 (第 1、8天 ) ,ADM 30mg/m2 静脉推注 (第 1天 ) ,每 2 1天为 1周期〕 ,并与同期未行任何术前治疗的可手术的30例Ⅲa期患者作对比分析。结果　新辅助化疗组的总有效率为 87.1% (2 7/31) ,有 6 1.3% (19/31)的患者分期降低 ,其中 6例降为Ⅲa期 ,8例降为Ⅱb期 ,4例降为Ⅱa期 ,1例降为 0期 ,临床完全缓解 1例 ,无病理完全缓解。新辅助化疗组的无病生存期为 5 6 .3个月 ,明显高于未行化疗组的 4 3.5个月 (P<0 .0 5 ) ,新辅助化疗组的 5年无病生存率为 38.7% ,略高于未化疗组的 33.3% ,两组间差异无显著性意义。结论　新辅助化疗能降低晚期乳腺癌患者的分期 ,为手术创造最佳机会 ,能明显延长晚期乳腺癌患者的无病生存期 ,减少或延缓肿瘤的复发、转移。     

国外医学文献摘要

新辅助化疗与辅助化疗治疗局部进展期乳腺癌(T4bN0～2M0)的疗效比较——一项随机对照研究DeoSV,BhutaniM,ShuklaNK,etal.JSurgOncol.2003,84(4):192鄄197.将101例可手术切除的局部进展期乳腺癌病人(T4bN0～2M0)随机分为新辅助化疗组和辅助化疗组,前者在手术前后分别接受3个周期     

ER、PR、HER2和Ki-67在乳腺癌新辅助化疗前后表达变化的临床意义

【摘要】 目的 探讨新辅助化疗前后ER、PR、HER2、Ki-67表达的改变与乳腺癌新辅助化疗疗效的关系。方法 收集广东省妇幼保健院乳腺外科2007年1月1日至2012年12月31日收治的72例接受新辅助化疗的ⅡA~ⅢC期的乳腺癌资料,回顾性分析临床特征、ER、PR、HER2及Ki-67表达水平与新辅助化疗疗效的关系。结果 72例乳腺癌患者新辅助化疗总有效率(RR)为76.4%(55/72),其中有16.7%(12/72) 病例达临床完全缓解(CR),59.7%(43/72)病例达临床部分缓解(PR)。23.6%(17/72)的病例为病情稳定(SD),无患者获得疾病进展(PD),病理完全缓解(pCR)7例(9.72%)。原发肿瘤大小、ER、PR、Ki-67表达与新辅助化疗的临床有效率相关(P<0.05);病理完全缓解率(pCR)与ER、PR状态相关(P<0.05);ER新辅助前后发生改变的约22.2%,PR发生改变的约25.0%,HER2发生改变的约15.3%,Ki-67发生改变的约55.6%;新辅助化疗疗效与ER、PR、Ki-67化疗前后的改变相关(P<0.05),与HER2的改变无关(P>0.05)。结论 乳腺癌新辅助化疗后ER、PR、HER2和Ki-67的表达可发生改变,并且ER、PR和Ki-67表达的改变可预测新辅助化疗的疗效。     

多西紫杉醇/顺铂/5-氟脲嘧啶新辅助化疗方案治疗局部进展期胃癌的临床研究

目的　了解多西紫杉醇加顺铂及 5 氟脲嘧啶的联合新辅助化疗方案治疗局部进展期胃癌的疗效和毒副作用。方法　自 2 0 0 1年 10月～ 2 0 0 3年 9月 ,有 37例局部进展期胃癌病人入组本次临床研究。入组病例术前接受的新辅助化疗方案为 :多西紫杉醇 75mg m2 ,第 1天 ;顺铂 75mg m2 ,第1天 ;5 氟脲嘧啶 50 0mg m2 ,第 1- 5天 ,每三周为一周期 ,共三个周期。观察新辅助化疗后肿瘤原发病灶的缓解情况 ,并观察新辅助化疗的毒副反应。结果　新辅助化疗后所有病人进行了根治性手术治疗 ,临床有效率为 51.4 % ,其中完全缓解 (CR)占 8.1% ( 3例 ) ,部分缓解 (PR)占 4 3.2 % ( 16例 ) ,疾病稳定 (SD)占 2 7.0 % ( 10例 ) ,疾病进展 (PD)占 2 1.6 % ( 8例 ) ,术后病理水平缓解率为 10 .8% ( 4 37) ,其中 2例达到完全缓解。毒副反应主要为白细胞减少症、腹泻、恶心 呕吐、脱发 ,共有 8例病人发生了Ⅲ～Ⅳ级的白细胞减少症 ,但未有因此而发生的败血症和死亡病例。结论　多西紫杉醇加顺铂及5 氟脲嘧啶的新辅助化疗方案在进展期胃癌的治疗中近期疗效显著 ,耐受性良好     

Combination chemotherapy of M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) for advanced uroepithelial cancer

Seventeen patients with advanced uroepithelial cancer were treated with M-VAC regimen. Out of 17 patients, 10 were evaluable but 7 were not. Evaluable 10 patients comprised 7 males and 3 females ranging in age from 50 to 83 (median 69.5). The number of performed cycle ranged from 1 to 3 and the performance status was from 0 to 2. Complete response (CR) was observed in 2, partial response (PR) in 4 and no change (NC) in 4 out of 10 patients. The efficacy rate was 60%. Every site of the tumor responded well and CR was observed, in particular, in nodal and pulmonary metastasis. One of 2 CR patients relapsed and died. One of 4 PR patients died of cancer, 2 are alive with regrowing tumors and the other is alive without disease after surgical removal of all residual tumors. The same regimen was carried out again to 2 patients with regrowing tumors, but no response was observed. As to drug toxicity in total 31 cycles (17 patients), gastrointestinal disturbances, anorexia and alopecia were reversible but hematological toxicity was serious and 3 of 17 (17.6%) died of severe bone marrow suppression. M-VAC is an effective regimen for advanced uroepithelial cancer, but bone marrow suppression was serious. Therefore, special attention should be paid to myelosuppression.     

Comparison of Doctors' and Breast Cancer Patients' Perceptions of Docetaxel,Epirubicin, and Cyclophosphamide (TEC) Toxicity

In Spain, around 26,000 cases of breast cancer are diagnosed each year, representing nearly 30% of all cancers in women. The aim this study was to compare the perceptions of nonhematologic toxicities after administration of a docetaxel, epirubicin, and cyclophosphamide (TEC) regimen between breast cancer patients and oncologists. Furthermore, the relationship between such adverse events and quality of life (QOL) was evaluated. Cross‐sectional study carried out among 92 breast cancer patients who received TEC as neoadjuvant or adjuvant treatment. The main nonhematologic toxicities experienced by breast cancer patients treated with the TEC regimen were asthenia, nausea, dysgeusia, arthralgia, headache, and myalgia. Patients were less likely to be affected by vomiting and peripheral neuropathy. Oncologists seemed to show greater interest in toxicities, such as asthenia, nausea, and diarrhea. Vomiting was the toxicity with the most substantial degree of agreement between oncologist and patient. Toxicities with greater disagreement were dysgeusia, arthralgia, myalgia, asthenia, and headache. Asthenia, dysgeusia, loss of appetite, skin allergies, peripheral edema, abdominal pain, and myalgia were found to significantly affect the QOL. Tolerability and QOL were more favorable in patients treated with pegfilgrastim compared with filgrastim. Oncologists tend to underestimate toxicities experienced by breast cancer patients treated with the TEC regimen. The establishment of a protocol to record these toxicities may reduce that problem.     

ET与CEF新辅助化疗方案的临床疗效比较

目的比较ET与CEF两种不同新辅助化疗方案治疗乳腺癌的疗效及不良反应。方法收集130例Ⅱa-Ⅲc期乳腺癌患者，分为两组，分别接受ET组（多西紫杉醇加表阿霉素）和CEF组（环磷酰胺加表阿霉素加5-Fu）化疗方案治疗。其中ET组64例，CEF组66例，化疗21天为1个周期。所有的患者均完成2—4个周期新辅助化疗后评价疗效。结果乳腺癌新辅助化疗总有效率（ORR）ET组为85．9％（57／64），CEF组为71．2％（47／66）。主要不良反应是脱发、乏力、恶心、呕吐、腹泻，两组间不良反应无显著性差异。ET组3度以上粒细胞缺乏、粒细胞缺乏性发热、外周性水肿、关节痛、肌痛、神经感觉异常发生率较CEF组高（P〈0．05），但不良反应均可耐受。结论两组新辅助化疗方案对乳腺癌的原发肿瘤均有效。ET组的疗效及不良反应均高于CEF组。     

Two Cycles of High Dose Chemotherapy with Autologous Bone Marrow Support for Patients with Locally Advanced Breast Cancer

Abstract: Purpose: To examine the impact of two cycles of high dose chemotherapy (HDC) with autologous bone marrow rescue (ABMR) in the treatment of women with locally advanced breast cancer. Patients and Methods: Twenty-three patients not exhibiting progressive disease to conventional dose therapy (ltx) were eligible for HDC. Conventional dose regimens used were the CAMFTP regimen (n= 6), 5-FU, doxorubicin and cyclophosphamide (n= 3), cyclophosphamide, methotrexate and 5-FU (n= 1), or doxorubicin/cyclophosphamide (n= 13). HDC on each cycle consisted of etoposide 625 mg/m², cyclophosphamide 6 gr/m², carboplatin 2 gr/m² with ABMR. Median age of the patients was 40 years. Results: Seventeen patients (74%) underwent two cycles of HDC; 6 received only one cycle due to insurance refusal to pay for C2 (1), toxicity from C1 (4), death on C1(1). There were 2 transplant-related deaths due to fungal infections 1 each on C1 and C2. Four patients achieved complete remission (CR) with Itx, 18 achieved partial remission (PR), and 1 had stable disease (SD). One patient was converted from PR to CR with HDC. There are 9/23 (39%) patients alive and progression-free with median follow-up of 27 months. (range 21-41 + months). Twelve of the 23 (52%) have progressed at a median of 7 months (range 4-32) from bone marrow transplant (BMT) and there were 2 early deaths (9%). Six patients received only one cycle of HDC and 2 of these are alive and progression-free at 36 and 38 months of follow-up. Of the 17 completing two cycles of HDC, 7/17 (41%) are alive and progression-free with follow-up of 21-41 months. The median progression-free survival (PFS) for the entire group is 13 months and median overall survival is 21 months (range 1–41 + mos). Conclusion: Despite the use of two cycles of HDC with ABMR, systemic relapse remains the major obstacle to cure in women with locally advanced breast cancer; there is a need to develop more effective preparative rgimens.     

含洛铂的联合方案治疗晚期乳腺癌临床观察

目的观察含洛铂的联合化疗方案治疗晚期乳腺癌的疗效和毒性不良反应。 方法33例晚期乳腺癌患者采用含洛铂（30 mg/m²）的联合化疗方案,21 d为1周期。至少化疗2个周期后,评价疗效和毒性不良反应。 结果33例患者均可评价疗效和毒性不良反应。获CR 1例,PR 11例,SD 14例,PD 7例;有效率为36.4%,疾病控制率为78.8%。中位无进展生存时间为6.5个月,中位总生存时间为14个月,1年生存率为75.8%。主要毒性不良反应为骨髓抑制和胃肠道反应,经对症处理后缓解。 结论含洛铂的联合方案治疗晚期乳腺癌疗效较好,毒性不良反应轻,值得临床推广。     

M-VAC chemotherapy for patients with lymph node metastases and/or locally advanced bladder carcinoma

Sixteen patients with lymph nodes metastases and/or locally advanced bladder carcinoma were treated with a combination chemotherapy regimen consisting of methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC) from November 1986 through September 1988. There were 14 men and 2 women. The median age was 61.9 years, with a range from 43 to 81 years. Complete response (CR) was observed in 6 of 16 patients (38%), partial response (PR) was confirmed in 5 of 16 patients (31%), and overall response rate was 69%. Median duration of response was 10.3 and 5.2 months in CR and PR patients, respectively. The myelosuppression with this regimen was tolerable. This study demonstrates that the M-VAC regimen is effective in the invasive bladder carcinoma with or without lymph nodes metastases. However, the duration of response is relatively short, and the true long-term benefits of this regimen remain to be determined.     

BCSG1基因在乳腺癌新辅助化疗疗效评估中的价值

目的:探讨乳腺癌特异基因（BCSG1）在乳腺癌新辅助化疗疗效评估中的价值。方法:采用免疫组化S P法和荧光定量PCR方法检测36例乳腺癌患者新辅助化疗(CEF方案)前后乳腺癌组织BCSG1的表达，比较化疗前后肿瘤体积的变化情况，分析新辅助化疗前后BCSG1蛋白表达与肿瘤形态学变化的关系。结果:36例乳腺癌患者新辅助化疗后肿瘤体积均有明显缩小（P<0.01），病灶缓解率(CR+PR)为85.6%；新辅助化疗后BCSG1 mRNA表达水平亦明显低于化疗前（P<0.05），BCSG1蛋白高表达率低于新辅助化疗前（P<0.01）。结论:乳腺癌新辅助化疗后BCSG1在分子和蛋白水平表达均明显降低，与新辅助化疗后疗效呈负相关（r=-0.539,P<0.01），提示BCSG1可作为乳腺癌新辅助化疗疗效的预测因子。     

Combination chemotherapy with methotrexate, vincristine, cisplatinum, cyclophosphamide, adriamycin, and bleomycin (MVP-CAB) for metastatic urothelial cancer]

We studied 31 patients with bidimensionally measurable metastases of urothelial cancer who were treated with a planned regimen (20 mg/m2 methotrexate, 0.6 mg/m2 vincristine, 500 mg/m2 cyclophosphamide, 20 mg/m2 adriamycin, and 30 mg bleomycin on day 1, and 50 mg/m2 cisplatinum on day 2) in cycles given every 3 weeks. CR was achieved in 4 patients (13%) and PR in 17 patients (55%). The response rates according to the disease characteristics were 71% for TCC, 33% for SCC, 67% for renal pelvis tumors, 67% for bladder tumors, 73% for lung metastases, 67% for liver metastases, and 67% for lymph node metastases. The median response duration and the number of cycles of therapy were 32 months/3 cycles for patients with a CR and 6 months/6 cycles for those with a PR. The median duration of survival was 32 months (range: 3-46) in CR, 11 months (range: 1-37) in PR, and 6 months (range: 2-10) in non responders (NC + PD). A significant prolongation of survival was noted in patients with either CR (p less than 0.01) or PR (p less than 0.05). Then main toxic effects were pulmonary fibrosis and myelosuppression. Two patients aged 73 and 81 died of pulmonary fibrosis. However, it was possible to prevent pulmonary fibrosis by not administering bleomycin to patients over 70 years of age, or to patients with pulmonary dysfunction. WBC count nadirs of less than 2,000/m3 were noted in 22 patients (71%). Platelet count nadirs of greater than 5 x 10(4)/mm3 were noted in 7 patients (23%). However, there were no deaths due to myelosuppression.     

Exemestane after non-steroidal aromatase inhibitors for post-menopausal women with advanced breast cancer

A retrospective analysis was performed on 31 consecutive locally advanced or metastatic breast cancer patients who commenced exemestane 25mg/d orally following previous treatment with Tamoxifen and a non-steroidal third-generation aromatase inhibitor (AI). Patients were seen 3 monthly until clinical or radiological disease progression. Median age was 64 years (range 34-90 yrs). The average number of recurrences before starting exemestane was three (range 1-6). There were two complete responses (CR), four partial responses (PR), 12 with stable disease (SD) and 12 with progressive disease (PD). Objective response rate (CR+PR) was 19.4% and overall clinical benefit (CR+PR+SD >or= 24 weeks) was 54.8%. The median durations of objective response and overall clinical benefit were 18 and 14 months, respectively. This data support the anti-tumour activity of exemestane 25mg daily in patients with locally advanced and/or metastatic breast cancer who have been previously exposed to non-steroidal AIs and Tamoxifen.     

新辅助放疗在低位直肠癌中的应用

目的探讨新辅助放疗在低位局部进展期直肠癌中的疗效及其对保肛手术的意义。方法回顾性分析2000~2005年39例行新辅助放疗低位直肠癌病人的临床资料。结果肿瘤距肛缘3~7 cm,平均4.9 cm。放疗后21例(53.8%)排便困难、便血等症状得以改善。腹会阴联合切除14例,低位前切除术13例,Parks术8例,Hartm ann术4例。术后病理显示肿瘤完全消退(CR)3例,肿瘤部分缓解(PR)22例,无效(NR)14例,总有效率为64.1%(25/39)。保肛率为53.8%(21/39),其中放疗有效者(CR PR)保肛率为64%(16/25),无效者为35.7%%(5/14),两者间差异有显著性意义(P<0.01)。结论新辅助放疗对多数直肠癌病人有效,可以使肿瘤缩小、降低分期,并可提高低位直肠癌的保肛率。