新辅助化疗治疗局部进展期乳腺癌的临床观察

目的 探讨新辅助化疗用于局部进展期乳腺癌的临床价值.方法 选取1996年1月至2006年12月经病理确诊的局部进展期乳腺癌522例,随机分为新辅助化疗组264例和对照组258例.新辅助化疗组给予FEC或TEC方案化疗4～6周期后进行手术,符合保乳条件者实施保乳手术;对照组实施全乳房切除术.分析新辅助化疗对局部进展期乳腺癌保乳率以及预后的影响.结果 新辅助化疗组总有效率为89.19%(231/259),82.20%(217/264)的患者达到保乳条件,其中实际实施保乳手术85例.经67.4(36～166)个月随访,新辅助化疗组的复发率、转移率、总生存率及无病生存率与对照组相比,差异均无统计学意义(P＞0.05);临床完全缓解者的总生存率和无病生存率分别为92.64%(63/68)、88.23%(60/68),高于未达到临床完全缓解者的81.15%(155/191)、73.82%(141/191),差异有统计学意义(P=0.026;P=0.017);病理完全缓解的35例患者OS、DFS分别为97.14%(34/35)、94.19%(33/35),未达到病理完全缓解的224例患者OS、DFS分别为81.25%(182/224)、75%(168/224),差异均有统计学意义(P=0.019;P=0.015).结论 新辅助化疗可以使局部进展期乳腺癌的原发肿瘤缩小,提高保乳率,准确地进行治疗前分期将是判断新辅助化疗对该癌预后影响的关键.     

新辅助化疗在乳腺癌保乳手术中的应用

乳腺癌传统的治疗是以外科手术为主,随着国内外对乳腺癌研究的不断深入,早期乳腺癌检出率的提高,近年来传统的Halsted手术已逐渐被淘汰,我国不少医院对Ⅰ-Ⅱ期乳腺癌患采用了保留乳房的手术方式,取得良好的效果。我院近几年对部分Ⅱ期乳腺癌实施保乳手术,现报告如下：     

新辅助化疗对早期乳腺癌保乳治疗的影响

乳腺癌是女性最常见的恶性肿瘤之一，且目前全球发病率呈逐年上升的趋势。随着临床诊断水平的提高，发现早期乳腺癌的比例正逐渐增加。目前，还没有统一的有关早期乳腺癌（early-stage breast cancer，EBC）的定义，在本文中我们采用了Cochrane Breast Cancer Group的标准，将肿瘤直径小于5cm，无同侧腋窝淋巴结受累或伴有同侧活动淋巴结的乳腺癌（包括了TNM分期的T1-2，     

新辅助化疗后乳腺癌保乳手术的安全性研究

[目的]探讨可手术乳腺癌新辅助化疗后保乳手术的安全性。[方法]107例乳腺癌患者使用4个周期新辅助化疗后确定保乳手术的可行性及安全性。[结果]41例患者影像学检查符合保乳治疗适应证,病理检验34例可以实施保乳手术。21例接受保乳手术治疗结束后乳房的美观程度优秀3例,好12例,一般5例,差1例。随访期间均未出现局部复发,3例患者出现远处转移。[结论]新辅助化疗后可以扩大保乳手术的适应证,使相当部分病人获得保乳的机会。新辅助化疗后行保乳手术是可行的。     

ⅢA期乳癌新辅助化疗后保乳手术的探讨

目的探讨ⅢA期乳腺癌患者保乳手术的可行性和相关技术问题.方法结合相关文献回顾性分析3例ⅢA期乳腺癌保乳患者的临床特点和新辅助化疗后保乳手术的诊治经过.结果新辅助化疗后3例患者的肿瘤和淋巴结均有明显缩小,其中1例获得了组织学上的完全缓解;术后无并发症;美容效果满意;分别随访40、20、11个月,至今尚未发现复发和转移的病例.结论部分ⅢA期乳腺癌在新辅助化疗后可以获得保乳机会,并有望获得和传统根治术相似的疗效.     

局部进展期乳腺癌的新辅助治疗

局部进展期乳腺癌(locally advanced breast cancer,LABC)包括进展期原发乳腺癌、区域淋巴结广泛转移和炎性乳癌。虽然经过积极治疗,患者预后仍然很差。综合治疗包括化疗、放疗、外科手术和新靶向药物的应用已显著提高了其临床疗效。但LABC仍然是临床面临的一个难题,尤其在发展中国家和难以普及乳腺癌筛查的国家。LABC的合理治疗方案需要内科、外科和放疗科之间的多学科讨论制定。作者就LABC目前的治疗现状展开讨论。     

乳腺癌保乳术中应用新辅助化疗方案治疗的疗效分析

目的 探讨新辅助化疗方案联合保乳术治疗乳腺癌患者临床效果.方法 截选70例Ⅱ~Ⅲ期乳腺癌患者按照随机抛硬币法分为对照组与观察组,各35例.其中对照组采用根治性切除术联合术后化疗治疗;观察组采用保乳术联合新辅助化疗治疗;均化疗2~4个疗程.统计两组手术情况及术后并发症;随访12个月,采用生活质量核心问卷评价两组患者各项生活质量变化,并统计两组预后.结果 观察组患者手术时间、术中出血量及术后住院时间均明显少于对照组,P<0.05;观察组术后并发症率为8.6%,明显低于对照组(42.9%),P<0.05.随访12个月,两组患者局部复发率、远处转移率及死亡率比较,P>0.05;两组患者治疗后12个月躯体功能、情绪功能、角色功能、认知功能及社会功能得分均较治疗前显著改善,但观察组各项指标改善程度均明显优于对照组,P<0.05.结论 应用保乳术联合新辅助化疗治疗Ⅱ~Ⅲ期乳腺癌疗效显著且安全,同时还可有助于改善患者生活质量,因此可作为Ⅱ~Ⅲ期乳腺癌临床治疗首选方案.     

乳腺癌的保乳治疗进展

随着乳腺癌研究的进展，人们重新审视乳腺癌生物学行为和相应的社会因素、价值观的改变，保留乳房治疗（breast-conserving therapy，BCT）从兴起至今，已被西方多数医生和患者所接受。在我国，由于患者甚至部分医生对乳腺癌概念的偏颇认识以及医疗条件等诸多方面的原因，BCT还未广泛开展。     

T2期乳腺癌新辅助化疗后行保乳手术的临床观察

目的 探讨T2期乳腺癌新辅助化疗后保乳手术治疗的可行性及疗效.方法 对有保乳愿望的T2期乳腺癌患者术前行新辅助化疗,2个周期后评价疗效,达到保乳手术指征的行保乳术,共36例,并随机抽取同期36例T2期乳腺癌根治术患者进行疗效对比.结果 保乳组36例患者,术前均经过2个疗程的新辅助化疗,并达到保乳指征后行保乳手术治疗,术后常规放疗、化疗.对照组36 例均行根治术,随访3～5年,两组无复发生存率分别为88%、86%,两者比较无统计学意义,P＜0.05.结论 T2期乳腺癌新辅助化疗后可提高保乳率,改善患者生活质量,随访3～5年,与同期根治术相比,治疗效果相同,值得临床推广应用.     

腔镜辅助下乳腺癌保乳术结合新辅助化疗的临床疗效观察

目的探讨腔镜辅助下乳腺癌保乳术结合新辅助化疗治疗乳腺癌的临床疗效。方法将2010年3月至2012年10月间收治的90例早期乳腺癌患者分为试验组和对照组,每组45例。试验组患者采用保乳术结合新辅助化疗治疗,对照组采用传统根治术疗法,比较两组患者的临床疗效。结果试验组患者的手术时间、术中出血量、住院时间和并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论腔镜辅助下保乳术结合新辅助化疗治疗乳腺癌临床疗效显著,值得临床进一步推广。     

46例局部晚期乳腺癌的新辅助化疗

目的 观察多西紫杉醇+表阿霉素+环磷酰胺联合(TAC方案)新辅助化疗在局部晚期乳腺癌治疗中的疗效和毒副反应.方法 46例未经治疗的Ⅱb～Ⅲc期的局部晚期乳腺癌(包括炎性乳腺癌)接受TAC方案的新辅助化疗.TAC方案:多西紫杉醇75mg/m2静脉滴注,d1;表阿霉素75 mg/m2静脉注射,d1;环磷酰胺500 mg/m2静脉注射,d1;21 d为1个疗程,共3个疗程.入组患者化疗前均接受肿瘤原发灶空芯针穿刺活检并获得病理组织学确诊.结果 TAC方案新辅助化疗在局部晚期乳腺癌的治疗中总有效率80.4%,其中临床完全缓解15.2%(7/46),临床部分缓解65.2%(30/46),病理完全缓解8.3%(4/46).主要的毒副反应为白细胞减少、脱发和恶心呕吐,发生肺栓塞1例,无败血症和死亡病例.结论 TAC方案新辅助化疗在局部晚期乳腺癌的治疗中疗效显著,耐受性好.     

Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer in a Malaysian Tertiary Hospital

Introduction: Neoadjuvant chemotherapy for locally advanced breast cancer is given with the aim of shrinkingthe disease sufficiently for surgery. However, many clinical trials investigating neoadjuvant chemotherapyregimens were conducted for operable breast cancer. Methods and Materials: Patients with T3-4, N2 M0 breastcancer diagnosed between January 2005 and December 2008 and who received at least one cycle of neoadjuvantchemotherapy were eligible for this study. Thirty-four patients were identified from the Chemotherapy DaycareRecords and their medical records were reviewed retrospectively. The neoadjuvant chemotherapy regimenadministered was at the discretion of the treating oncologist. Breast tumour size and nodal status was assessedat diagnosis, at each cycle and before surgery. Results: All 34 patients had invasive ductal cancer. The medianage was 52 years (range 27-69). 65% had T4 disease and 76% were clinically lymph node positive at diagnosis.The median size of the breast tumour at presentation was 80 mm (range 42-200 mm). Estrogen and progesteronereceptor positivity was seen in less than 40% and HER2 positivity, by immunohistochemistry, in 27%. Themajority (85%) of patients had anthracycline based chemotherapy, without taxanes. The overall response rate(clinical CR+PR) was 67.6% and pathological complete responses were apparent in two (5.9%). 17.6% ofpatients defaulted part of their planned treatment. Recurrent disease was seen in 44.1% and the median time torelapse was 11.3 months. The three year disease free and overall survival rates were 52.5% and 58% respectively.Conclusion: Neoadjuvant chemotherapy for locally advanced breast cancer in a Malaysian setting confersresponse and pCR rates comparable to published clinical trials. Patients undergoing neoadjuvant chemotherapyare at risk of defaulting part of their treatment and therefore their concerns need to be identified proactivelyand addressed in order to improve outcomes.     

Prognostic Factors of Locally Advanced Breast Cancer PatientsReceiving Neoadjuvant and Adjuvant Chemotherapy

Background: Neoadjuvant chemotherapy is known to be beneficial for down-staging patients with locallyadvanced breast cancer. Clinical stage, degree of cell differentiation and expression of estrogen/progesteronereceptors and HER2/neu are all prognostic factors that may effect survival of patients with locally advancedbreast cancer. The present study was conducted to determine their influence in a series of Indonesian patientsMaterials and Methods: The subjects were a total of 52 patients with locally advanced breast cancer in SardjitoGeneral Hospital Yogyakarta, from January 2003 to June 2006. Survival analysis with Kaplan Meier was testedfor age, clinical stage, degree of histological differentiation, estrogen-progesterone receptor (ER/PR), HER-2expression and neoadjuvant as well as adjuvant chemotherapy. To find the most important influencing factors,significant variables were tested with multivariate Cox regression. Result: Of the 52 patients with locallyadvanced breast cancer, most were between 40-60 years old (41, 78%), almost half were stage IIIA (23 ,44%),and the majority were negative for ER and PR (32, 61%). Her2 positivity was found in 29 patients (55%) and amoderate histological grade in 26 (50%). Thirty-nine patients were alive at the end of the study period (75%).There were no significant differences in survival between patients with and without adjuvant and neoadjuvantchemotherapy. Tumor characteristics that did influence survival were advanced stage (p<0.001) and histologicalgrade (p<0.001), while HER-2 and ER/PR hormonal status had no effect. Conclusion: Clinical stage and degreeof histological grade are the most significant prognostic factors for Indonesian locally advanced breast cancercases, while hormonal status and HER-2 did not appear impact on our patient’s survival.     

局部晚期乳腺癌新辅助化疗疗效观察

目的比较3组不同化疗方案在局部晚期乳腺癌新辅助化疗中的疗效及毒副反应。方法90例Ⅱ、Ⅲ期乳腺癌随机分为2组,每组45例。A组应用CAF方案（环磷酰胺＋吡柔比星＋5-氟脲嘧啶）,B组用TA方案（多西他赛＋吡柔比星）新辅助化疗。完成2个周期新辅助化疗后评价疗效。结果A组总有效率为55．6％,B组的总有效率为82．3％,差异有统计学意义（P〈0．05）。2组胃肠反应相似,A组发生率为84．4％,B组发生率为88．9％,差异无统计学意义（P〉0．05）。B组骨髓抑制和脱发发生率分别为92．3％和84．4％,明显高于A组的73．3％和53．3％,差异有统计学意义（P〈0．05）。结论2组新辅助化疗方案对乳腺癌治疗均有效,毒副反应均可耐受。TA组疗效及毒副反应均高于CAF组。     

Taxane and Anthracycline Based Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer : Institutional Experience

Background: The aim of this study was to assess the response rates (clinical and pathological ) with docetaxeland epirubicin combination chemotherapy and its effect on outcome. Materials and Methods: We retrospectivelyanalysed locally advanced breast cancer (LABC) patients who received NACT from January 2008 to December2012 in our tertiary care centre. LABC constituted 37% of all breast cancer cases and 120 patients fulfilled theeligibility criteria. The regimens used for NACT were, six cycles of DEC (docetaxel 75 mg/m2, epirubicin 75 mg/m2, cyclophosphamide 500 mg/m2 on Day 1, 3 weekly) and a sequential regimen (4 cycles of FEC, 5-flurouracil600 mg/m², epirubicin 75 mg/m², cyclophosphamide 600 mg/m² followed by 4 cycles of docetaxel 85 mg/m2).Results: The median age was 47 years (range 23-72). Ninety six ( 80 %) had T4 disease and 90% had clinicallypalpable lymph nodes at diagnosis. The median size of primary tumor at presentation was 5.9 cm. Hormonereceptor positivity was seen in 55% and HER2/neu positivity, in 25%. Triple negative breast cancers constituted25 % of the cases. The overall clinical response rate ( complete or partial ) was 85% and pathological completeresponses were obtained in 15%. Four cases defaulted, 5 patients died of treatment related toxicity and 15%developed febrile neutropenia on DEC. The median duration of follow up was 22 months. The median time torelapse was 20 months and the 3 year relapse free and overall survival rates were 50% and 70% respectively.Conclusions: LABC constituted 37% of all breast cancer cases at our institute. With NACT, pCR was seenin 15% of the cases. Sequential chemotherapy was better tolerated than concurrent anthracyline and taxanechemotherapy with a similar pCR.     

Neoadjuvant Combination Chemotherapy with Pegylated Liposomal Doxorubicin and Vinorelbine for Locally Advanced Breast Cancer

OBJECTIVE In China, vinorelbine plus an anthracycline is a common neoadjuvant regimen for locally-advanced breast cancer (LABC).Pegylated liposomal doxorubicin (PLD) is an alternate anthracycline formulation with a more favorable safety profile compared with conventional anthracyclines.METHODS In this open-label trial, 61 women with LABC received up to 6 cycles of PLD 30 mg/m2 on Day 1 and vinorelbine 25 mg/m2 on Days 1 and 8 every 21 days. Hormone receptor and/or HER2 status was not routinely available.RESULTS The overall clinical response rate (primary efficacy endpoint) was 80% (95% CI: 68%-89%). Two patients achieved a pathological complete response (3%), with 75% having their tumor down-staged, and 89% proceeding to tumor resection. The most frequent nonhematologic adverse events were stomatitis, fever,rash, and palmar-plantar erythrodysesthesia, with none considered serious. Grade 3 or 4 neutropenia and thrombocytopenia occurred in 10% and 2% of patients, respectively.CONCLUSION PLD plus vinorelbine demonstrated comparable efficacy to conventional anthracyclines plus vinorelbine in the neoadjuvant treatment of LABC, but may offer safety advantages.     

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.