紫杉醇脂质体联合表阿霉素方案在乳腺癌新辅助化疗中的近期疗效

[目的]观察紫杉醇脂质体在乳腺癌新辅助化疗中的疗效、毒副反应。[方法]回顾性分析20例局部晚期乳腺癌患者含紫杉醇脂质体方案新辅助化疗的疗效、毒副作用。化疗方案为紫杉醇脂质体加表阿霉素，21d为一周期，术前化疗2～6个周期，评估肿瘤缓解情况及毒副反应。[结果]化疗有效率为90％，其中CR3例，PR15例，SD1例，PD1例，达pCR1例。[结论]紫杉醇脂质体联合表阿霉素方案在乳腺癌的新辅助化疗中疗效肯定．毒副反应低．值得进一步研究。     

局部晚期乳腺癌新辅助化疗后肿瘤退缩模式的病理大切片研究

[目的]探讨局部晚期乳腺癌新辅助化疗后残留病灶的退缩模式。[方法]21例初治局部晚期乳腺癌患者,分别行2~4个周期新辅助化疗。全组病例均在新辅助化疗后行乳腺癌改良根治术或标准根治术,术后标本制作病理大切片,评价残留病灶的退缩模式。[结果]18例（85.7%）患者肿瘤的退缩模式为在原肿瘤范围内的原位消散,残留肿瘤细胞密度降低并出现不同程度的变性。3例（14.3%）呈向心性退缩且周围无癌灶残留。[结论]局部晚期乳腺癌新辅助化疗后的肿瘤退缩模式大部分为在原肿瘤范围内的原位消散,但病理范围并没有缩小。     

ER和Ki-67对63例局部晚期乳腺癌新辅助化疗疗效的观察

通过回顾性分析局部晚期乳腺癌新辅助化疗的疗效进而明确生物标志物对疗效和预后的判断意义。方法：分析2006年1月至2007年12月间63例接受新辅助化疗局部晚期乳腺癌患者,免疫组化法检测ER、HER-2、Ki-67表达情况,术后均接受辅助放疗,并根据激素受体情况选择内分泌治疗。结果：全部患者新辅助化疗有效率达93.6%,不良反应可以耐受。生物标志物表达差异与疗效无明显的相关性,中位随访42个月后,单因素分析显示术前Ki-67≥30%、化疗前与术后ER（-）及术后HER-2（++～+++）是局部晚期乳腺癌无病生存率的不良预后因素。多因素回归分析显示治疗前ER（-）和术后HER-2（++～+++）是对无病生存率有独立影响的不良预后因素（P<0.05）。结论：治疗前ER（-）是局部晚期乳腺癌最重要的不良预后因素,化疗前测定的Ki-67指数和ER表达情况更能反应肿瘤的恶性程度。     

多西他赛联合表阿霉素同步放疗新辅助治疗10例局部晚期乳腺癌

[目的]评估同步新辅助放化疗治疗局部晚期乳腺癌的临床疗效和毒副作用。[方法]10例不可切除ⅢB期局部晚期乳腺癌在术前接受多西他赛联合表阿霉素同步放疗新辅助治疗,新辅助放化疗结束后2～3周手术,评价疗效与毒副作用。[结果]10例患者新辅助治疗后肿块缩小,均完成改良根治术,无一例皮瓣坏死。血液系统和消化道毒性反应较轻。无严重的神经系统以及心脏毒性反应。[结论]局部晚期乳腺癌患者联合化疗、手术与放疗可以显著提高局部治疗疗效．毒副作用可耐受。     

紫杉类新辅助治疗人表皮生长因子受体2阳性乳腺癌的近期疗效分析

目的探讨HER-2阳性乳腺癌对含紫杉类新辅助化疗的敏感性。方法回顾分析159例HER-2阳性的进展期乳腺癌新辅助化疗疗效,采用X2检验比较蒽环类为主化疗方案（蒽环组）和紫杉类为主化疗方案（紫杉组）病理完全缓解率和化疗有效率的差异。结果葸环组和紫杉组的病理完全缓解率分别为7．4％和25．6％,紫杉组明显高于葸环组（X2=9．658,P=0．002）;化疗有效率分别为85．2％和80．8％,两组间差异无统计学意义（x2=0．550,P=0．458）。结论HER-2阳性的进展期乳腺癌患者选择含紫杉类药物联合化疗方案可取得更好的病理完全缓解率。     

TE方案与TEC方案在乳腺癌新辅助化疗中的疗效比较

[目的]对比分析多西他赛联合表柔比星加/不加环磷酰胺（TEC/TE）两种新辅助化疗方案治疗乳腺癌的近期疗效。[方法]回顾性分析2006~2009年收治的Ⅱ~Ⅲ期乳腺癌新辅助化疗患者108例的临床病理资料,分别术前接受新辅助化疗的TE方案（n=62）及TEC方案（n=46）,两组患者均在术前接受2~4个周期化疗。TE方案：多西他赛75mg/m2,第1天静脉滴注;表柔比星（EPI）60mg/m2,第1天静脉滴注。[结果]全组108例患者均可评价疗效,CR 10例（9.25%）,PR 75例（69.44%）。TE组有效率为75.81%,而TEC组有效率为82.61%,两组有效率无统计学差异（χ2=0.729,P=0.392）。Ⅱ期患者28例均生存。Ⅲ期患者80例3年生存率为82.4%,其中TE组44例3年生存率为74.6%;而TEC组36例3年生存率为91.8%,差异有统计学意义（χ2=4.149,P=0.042）。[结论]在Ⅱ~Ⅲ期乳腺癌患者新辅助化疗中,TE与TEC方案近期疗效相似,TEC组3年生存率较佳,有待于进一步加大样本量进行研究。     

多西他赛联合卡培他滨在乳腺癌新辅助化疗中的应用

背景与目的：新辅助化疗已成为治疗局部晚期乳腺癌的主要手段之一,随机试验证明新辅助化疗与术后辅助化疗同样有效,并且能提高保乳率。本文旨在观察多西他赛联合卡培他滨在局部晚期乳腺癌新辅化疗应用中的近期疗效及不良反应。方法：52例局部晚期乳腺癌患者,接受多西他赛75mg/m2静脉滴注,第1天;卡培他滨2000mg/m2,分2次口服,第1～14天。21d为1个周期。治疗3～4个周期后评价疗效及不良反应。结果：新辅助化疗临床疗效总有效率（CR＋PR）为80.7%,其中3例（5.8%）为病理完全缓解。主要不良反应是粒细胞减少、脱发和手足综合征等。结论：多西他赛联合卡培他滨治疗局部晚期乳腺癌疗效显著,不良反应可耐受,是局部晚期乳腺癌新辅助化疗的有效方案。     

局部晚期乳腺癌的新辅助化疗

乳腺癌是全身性疾病,新辅助化疗在乳腺癌治疗策略上的转变有着划时代意义。国外报道新辅助化疗治疗Ⅲ期局部晚期乳腺癌(locally advanced breast cancer,LABC)已显示出了比较理想的效果[1],成为LABC治疗的标准方案之一。目前新辅助化疗已被不少大中医院乳腺科采用。我院自2003年1月至2006年10月对36例局部晚期乳腺癌患者进行新辅助化疗,收到了良好的效果,现报告如下。一、资料与方法1.一般资料:2003年1月至2006年10月在我院住院治疗乳腺癌221例,其中局部晚期48例,对其中愿接受新辅助化疗且无化疗禁忌证者36例术前行新辅助化疗。36例均为…     

局部晚期乳腺癌术前化疗的疗效分析

目的：探讨新辅助化疗应用于局部晚期乳腺癌患者的疗效。方法：回顾性分析62例局部晚期乳腺癌患者进行新辅助化疗的临床资料,62例患者手术前均进行TA方案化疗4段,其中吡柔比星50mg/m^2,d1,多西他赛135mg/m^2,d2,3周方案,化疗后白细胞低下者予以对症治疗,手术后的治疗方案依据新辅助化疗疗效及病理结果而定。结果：新辅助化疗有效率为90.3%（56/62）,其中完全缓解6.5%（4/62）,术后随访6个月至60个月,50例存活,其中41例为无病生存,占68.3%,死亡12例。结论：新辅助化疗能使局部晚期乳腺癌原发灶和腋窝淋巴结缩小,肿瘤降期,减少肿瘤的远处转移和复发,改善患者预后,且临床毒副反应可以耐受。     

新辅助化疗对局部晚期乳腺癌术后局部复发的影响

目的探讨新辅助化疗对局部晚期乳腺癌术后局部复发的影响。方法将我院1995年1月至2000年1月间完成术后系统治疗的128例局部晚期乳腺癌病例,根据是否新辅助化疗分为A(行新辅助化疗组)、B(未行新辅助化疗组)两组对照,通过总结两组的复发情况,分析新辅助化疗对局部晚期乳腺癌术后局部复发的影响。结果A组69例中有9例复发,复发率13.0%;B组59例中有20例复发,复发率33.9%,两组复发率差异有显著性(P<0.05)。A组复发者中多为单发,便于复发后的再治疗。结论CTF方案术前新辅助化疗可以降低局部晚期乳腺癌的术后局部复发率。     

oh8dG在恶性肿瘤中的研究进展

[目的]观察和评价培美曲塞联合顺铂治疗晚期复治乳腺癌的疗效及不良反应。[方法]回顾性分析2008年1月-2011年1月经病理证实的晚期复治乳腺癌患者38例．接受培美曲塞联合顺铂化疗方案治疗。对其疗效进行评价。[结果]全组38例均可评价疗效,患者有效率（CR＋PR）为39．5％,疾病控制率（CR＋PR＋SD）为73．7％;中位TrP为5个月,中位OS为12个月;主要不良反应为皮疹、黏膜炎、恶心呕吐和骨髓抑制。[结论]培美曲塞联合顺铂治疗晚期复治乳腺癌有一定的疗效,且毒性反应轻,可耐受,可以作为晚期乳腺癌治疗的方案之一。     

Weekly taxane–anthracycline combination regimen versus tri-weekly anthracycline-based regimen for the treatment of locally advanced breast cancer: a randomized controlled trial

Background: Extensive studies have confirmed the efficacy of taxanes in combination with anthracycline-basedchemotherapy on breast cancer. However, few studies have assessed the efficacy of weekly taxane–anthracyclineregimens on locally advanced breast cancer. This study was to compare the efficacy and safety of a weekly taxane–anthracycline regimen with those of tri-weekly anthracycline-based regimen in patients with locally advanced breastcancer.Methods: Patients with locally advanced breast cancer were randomized to receive 4–6 cycles of neoadjuvant chemotherapywith tri-weekly 5-fluorouracil–epirubicin–cyclophosphamide (FEC) regimen or weekly paclitaxel–epirubicin(PE) regimen. The primary endpoint was the pathologic complete response (pCR) rate. Other endpoints included theclinical tumor response, breast-conserving surgery rate, and adverse events.Results: Between March 2010 and September 2013, 293 patients were randomized to the FEC (n = 151) and PE(n = 142) arms. The overall clinical response rate was significantly higher in the PE arm than in the FEC arm (76.06% vs.59.95%, P = 0.001). Consistently, the post-chemotherapy pathologic T and N stages were significantly lower in the PEarm than in the FEC arm (P < 0.001). However, the pCR rate was similar in the two arms (10.61% vs. 12.31%, P = 0.665).Overall, 36 (27.27%) patients in the FEC arm and 6 (35.28%) in the PE arm were qualified for breast-conserving surgery.Most adverse events were comparable in both arms, with more severe neutropenia in the PE arm than in the FEC arm(11.97% vs. 5.96%, P = 0.031).Conclusions: In patients with locally advanced breast cancer, weekly PE was not superior to FEC in terms of pCR.However, weekly PE has a higher response rate and superior down-staging effects. On this account, the PE regimenmay be considered an alternative option for locally advanced breast cancer. Long-term follow-up data are needed toconfirm the efficacy of this regimen on locally advanced breast cancer.     

Locally advanced breast cancer

Opinion statement Over the past 20 years, the prognosis for women diagnosed with locally advanced breast cancer (LABC; clinical stages IIB through IIIB) has improved significantly with recognition of the efficacy of multimodal therapy for reducing both local and distant recurrences, even in patients with inflammatory breast cancer (IBC). Most patients will respond to induction, or neoadjuvant, chemotherapy (NAC) with an anthracycline-based regimen, enabling many patients with large but operable tumors to undergo breast-conserving surgery (BCS) and enabling resection in most patients with inoperable disease. However, only a small percentage of patients achieve a pathologic complete response (CR) with this approach. Long-term disease-free survival (DFS) and overall survival (OS) correlate with the extent of residual disease in the breast and axillary nodes following NAC. The addition of paclitaxel or docetaxel, either in combination with an anthracycline or as a separate regimen administered before or after anthracycline-based therapy, increases clinical and pathologic response rates and may improve DFS. With the possible exception of patients with IBC, BCS does not compromise outcome. Partial mastectomy should be accompanied by standard nodal dissection in patients with clinically or radiographically positive axillae; in patients with negative axillae, sentinel lymph node (SLN) sampling, with subsequent axillary dissection reserved for patients with involved nodes, may reduce postoperative morbidity. Patients who received only anthracycline-based NAC who are found to have significant residual disease in the breast or involved axillary nodes at surgery should receive adjuvant chemotherapy with paclitaxel. Postoperative radiation to the residual breast or chest wall and regional nodal areas reduces locoregional recurrences, but its impact on OS remains controversial. Adjuvant hormonal therapy with tamoxifen improves DFS and OS in patients with hormone receptor (HR)-positive tumors, and ovarian ablation should be considered in premenopausal patients with HR-positive tumors and multiple involved nodes or stage IIIB disease. Neoadjuvant hormonal therapy with either tamoxifen or an aromatase inhibitor may benefit frail or elderly patients with HR-positive tumors for whom chemotherapy is not an option. No advantage has been demonstrated for highdose chemotherapy requiring hematopoietic stem-cell support as either NAC or adjuvant therapy in LABC. Newer treatment approaches, including trastuzumab (Herceptin, Genentech, Inc., South San Francisco, CA), in patients with Her-2-overexpressing tumors or other biologic agents, do not have a proven role in the management of LABC at this time.     

Response and Prognosis of Docetaxel and Cyclophosphamide as Neoadjuvant Chemotherapy in ER+ HER2− Breast Cancer: A Prospective Phase II Study

BackgroundAlthough a docetaxel and cyclophosphomide (TC) regimen without anthracycline as adjuvant therapy became one of the standard regimens especially for ER-positive (ER⁺)/human epidermal growth factor receptor 2-negative (HER2⁻) primary breast cancer, the efficacy of TC as neoadjuvant chemotherapy (NAC) is not known. We conducted the prospective trial to assess the efficacy of a TC regimen in the neoadjuvant setting for stage II to III ER⁺/HER2⁻ primary breast cancer.Patients and MethodsA TC regimen that included 75 mg/m² of docetaxel and 600 mg/m² of cyclophosphamide for 4 cycles every 3 weeks was administered as NAC. Primary endpoints are the rate of clinical response (clinical partial response and clinical complete response) and pathologic complete response; secondary endpoints are the disease-free survival and overall survival rates.ResultsThirty (71.4%) of 42 tumors had clinical response. No patient achieved pathologic complete response. At the median follow-up period of 105.2 months (range, 12.1-119.7 months), the disease-free survival rate was 81.6%, and the distant disease-free survival rate was 86.8%. In terms of survival, only 1 patient died during the study period. The overall survival rate was 97.4% during the study period. Patients who developed distant recurrence had a trend to have progesterone receptor-negative or weakly positive compared with those who did not develop any recurrence (85.7% vs. 45.2%; P = .05).ConclusionsOur prospective study showed that a TC regimen as NAC achieved a high clinical response rate in stage II to III ER⁺/HER2⁻ breast cancer. A TC regimen without anthracycline as NAC might be one of the options for patients with ER⁺/HER2⁻ breast cancer without high-risk factors including progesterone receptor negativity.     

多西紫杉醇联合表柔比星新辅助化疗治疗老年局部晚期乳腺癌30例

[目的]观察多两紫杉醇联合表柔比星（TE）新辅助化疗治疗老年局部晚期乳腺癌（LABC）的客观缓解率、手术切除率及毒副反应。[方法]2005年10月至2008年8月,30例经空芯针活检组织学诊断证实的老年LABC行TE方案新辅助化疗,Ⅲa期17例,Ⅲb期11例,Ⅲc期2例,中位年龄74岁;化疗剂量为：多西紫杉醇75mg/m2,d1静滴,表柔比星60mg／m2,d1静滴,每3周为1个周期：2个周期TE方案之后对病灶进行首次评估,以决定是否再给予1～2个周期TE后再接受手术或放射治疗．[结果]30例患者接受2～4个周期TE方案的新辅助化疗,25例降低了临床分期,降期率为75．0％（25／30）：临床完全缓解率（CCR）及临床部分缓解率（CPR）分别为23．3%（7／30）、53.3％（16／30）;手术切除率为96．7％（29／30）。常见毒副反应有：中性粒细胞减少症、轻中度脱发、恶心、呕吐、体液潴留、肌肉关节疼痛等。Ⅲ、Ⅳ度中性粒细胞减少症分别为23．3％（7／30）和3.3％（1／30）。[结论]TE方案新辅助化疗治疗老年LABC患者是安全有效的,可以降低临床分期,提高患者术后的生活质量。     

吉西他滨联合顺铂方案治疗晚期乳腺癌临床研究

[目的]观察吉西他滨联合顺铂方案治疗晚期乳腺癌的近期疗效和毒副反应。[方法]38例晚期乳腺癌患者给予GP方案化疗：吉西他滨1000mg/m2,d1、d8,顺铂30mg/m2,d1～d3,21d为1个周期。每2个周期评价疗效。[结果]38例患者中位治疗周期数为6个周期（2～10个周期）,获CR 3例（7.9%）,PR 13例（34.2%）,SD 10例（26.3%）,PD 12例（31.6%）,总有效率（CR＋PR）为42.1%。主要毒副作用为骨髓抑制和胃肠道反应。Ⅲ度或Ⅲ度以上毒副反应为白细胞下降（36.84%）、中性粒细胞下降（36.84%）、血小板减少（15.79%）、呕吐（13.15%）和贫血（7.89%）。[结论]吉西他滨联合顺铂治疗晚期乳腺癌近期疗效好,毒副反应可以耐受,可作为晚期乳腺癌的治疗选择。     

局部进展期乳腺癌趋化因子受体CXCR4的表达与新辅助化疗疗效的相关性及预后研究

背景与目的:目前已经确立新辅助化疗在局部进展期乳腺癌(local advanced breast cancer,LABC)治疗中的地位,达到病理完全缓解者可提高生存率,但仍有大量患者复发、死亡,而无法从中受益。因此,我们迫切需要从分子水平找到可以预测新辅助化疗效果和预后的指标。目前已经证实趋化因子受体CXCR4与乳腺癌的侵袭和转移有关,然而关于CXCR4能否作为LABC患者新辅助化疗中的疗效指标和预后指标,目前却鲜有报道。本研究中,我们采用紫杉醇联合蒽环类的新辅助化疗方案治疗LABC,同时比较CXCR4低表达和高表达与疗效和远期生存的相关性。方法:对接受4个周期紫杉醇联合蒽环类的新辅助化疗方案进行治疗的86例ⅡB～ⅢB期(参照2002年AJCC乳腺癌TNM分期标准)LABC患者资料进行回顾性分析。用免疫组织化学法检测新辅助化疗前后乳腺癌组织CXCR4的表达,分析新辅助化疗对CXCR4低表达和CXCR4高表达患者的临床、病理疗效及其与远期生存的关系。结果:86例患者中58例(67.4%)为CXCR4高表达,28例(32.6%)为CXCR4低表达,新辅助化疗后,CXCR4高表达49例(57.0%),低表达37例(...     

A modified administrated schedule for combination therapy with irinotecan and cisplatin as a neoadjuvant chemotherapy in locally advanced cervical cancer--a report of 2 cases as a pilot study

To shorten the treatment term of neoadjuvant chemotherapy (NAC) for locally advanced cervical cancer, a combination of irinotecan (CPT-11) and cisplatin was administered on a modified administrated schedule for 2 eligible patients as a pilot study. CPT-11 70 mg/m2 was administered (div) on days 1 and 8, followed by cisplatin 70 mg/m2 given (div) on day 1. Treatment was repeated every 3 weeks for a total of two cycles. Both patients showed a complete clinical response. No severer toxicities were observed than with the usual regimen, and both cases could undergo radical hysterectomy after NAC. The results suggest that this modified regimen of combination of CPT-11 and cisplatin can be effective as an NAC in cases of locally advanced cervical cancer, especially in terms of shortening treatment term. This regimen is worthy of further study.     

The Efficacy of Neoadjuvant Chemotherapy Compared to Postoperative Therapy in the Treatment of Locally Advanced Breast Cancer

The current approach to the treatment of locally advanced breast cancer is sequential chemotherapy, surgery and/or radiation, and consolidation chemotherapy. Although significant tumor response is seen with this regimen, there are few studies that compare this approach to postoperative chemotherapy. The purpose of this study was to compare the disease-free and overall survival of patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and surgery to patients treated with surgery followed by adjuvant chemotherapy. Ninety-four patients with stage IIB, MA, and MB breast cancer were treated with a standardized chemotherapy regimen. The first group, 60 patients who were followed prospectively, was treated with neoadjuvant chemotherapy (NCT) consisting of vincristine, prednisone, Cytoxan, methotrexate, and 5-FU (CVFMP) followed by surgery and consolidation chemotherapy with adriamycin. The second group, 34 patients evaluated retrospectively, had surgery followed by postoperative chemotherapy (PCT) with CVFMP followed by adriamycin. Overall median follow-up was 38 months. In the NCT group, 45/60 (75%) patients had a clinical response to induction therapy and the median reduction in tumor size was 50%. The rates of local recurrence, distant recurrence, and death from disease were similar in the two groups. The time to local recurrence was similar for the two groups. However, the median time to distant recurrence was shorter in the NCT group (19 month vs. 31 months, p = NS). Overall median survival among the NCT patients was shorter than for the PCT group (30 vs. 47 months, p = NS). The current study suggests that postoperative therapy is comparable to a neoadjuvant regimen in patients with locally advanced breast cancer with regard to local recurrence, distant recurrence, and overall survival.