新辅助化疗后保乳治疗局部进展期乳腺癌52例疗效分析

目的]探讨局部进展期乳腺癌新辅助化疗降期后保乳手术的可行性及新辅助化疗后保乳手术的选择标准。方法]2005年1月至2011年10月本院接受新辅助化疗后行保乳治疗的52例局部进展期乳腺癌患者，化疗方案：吡柔比星50 mg/m2，紫杉醇150 mg/m2，21 d为1周期，共3～4周期，符合保乳条件者新辅助化疗完成后行保乳手术。术后常规放疗、化疗和内分泌治疗。结果]新辅助化疗总有效率92．3％（48/52），新辅助化疗完成后，13例（25％）临床完全缓解（cC R ），6例（11．5％）病理完全缓解（pC R ），35（67．3％）例临床部分缓解，无进展病例。经过36个月中位随访（18～78个月），局部复发率11．5％（6/52）；5例术后发生远处转移，远处转移率9．6％（5/52），其中2例已死亡。保乳综合治疗后满1年进行乳腺外形评估，外形优17．3％（9/52），良40．4％（21/52），差42．3％（22/52）。结论]经新辅助化疗降期后的局部进展期乳腺癌保乳手术治疗效果满意，严格把握新辅助化疗后的保乳指征，规范的手术治疗及术后综合治疗是保乳治疗成功，降低局部复发率的关键。

Analysis of the Efficacy of Breast Conserving Treatment for 52 Cases of Locally Advanced Breast Cancer after Neoadjuvant Chemotherapy

Objective] To explore the feasibility and selection criteria of breast conserving treatment （BCT） for locally advanced breast cancer after neoadjuvant chemotherapy （NAC） .Methods]A total of 52 pa-tients with locally advanced breast cancer in our hospital from Jan .2005 to Oct .2011 underwent BCT after NAC .The chemotherapy scheme was pirarubicin 50mg/m2 and paclitaxel 150mg/m2 for 3~4 cycles with 21 days as a cycle .Patients eligible for BCT underwent NAC .After the surgery ,conventional radiotherapy , chemotherapy and endocrine therapy were given .Results]The overall response rate of NAC was 92 .3% （48/52） .After NAC ,13 patients（25% ） were clinical complete response（cCR ） ,and 6 patients（11 .5% ） were pathological complete response（pCR） ,and 35 patients（67 .3% ） were clinical partial response（cPR） .No dis-ease progression was observed .After follow-up for median 36 months（18~78 months） ,local recurrence rate was 11 .5% （6/52） .Distant metastasis occurred in 5 patients（9 .6% ,5/52） and 2 of them died .After BCT for 1 year ,the assessment of cosmetic results showed that excellent rate was 17 .3% （9/52） ,and the good rate was 40 .4% （21/52） ,and poor rate was 42 .3% （22/52） .Conclusion] BCT for with locally advanced breast cancer after the downstaging NAC has satisfactory effect .Strict assurance of the indications of BCT after NAC ,normative surgical therapy and postoperative comprehensive therapy are the key to improve the success-ful rate of BCT and reduce local recurrence rate .