局部晚期乳腺癌的治疗体会

目的:观察85例III期乳腺癌患者治疗的疗效,寻找提高疗效的策略。方法:2003年6月至2005年12月85例III期乳腺癌患者接受了外科手术治疗,根据是否接受新辅助化疗分为手术组(41例)和新辅助化疗组(44例),比较两组的手术性质及治疗结果。结果:新辅助化疗组的无病生存期为59.1个月,明显高于手术组的43.1个月(P<0.05),新辅助化疗组的5年无病生存率为36.16%,手术组为34.14%(P>0.05)。结论:局部晚期乳腺癌患者接受新辅助化疗后手术可提高无病生存时间,值得临床推广。     

新辅助治疗在局部晚期乳腺癌中的应用

目的：探讨新辅助治疗在局部晚期乳腺癌治疗中的应用。方法：回顾性分析36例局部晚期乳腺癌患者进行新辅助治疗的临床资料：结果：36例患者中29例(80％)经新辅助治疗后病情缓解，可以手术。其中27例由化疗获得，2例由内分泌治疗获得。结论：大多数局部晚期乳腺癌患者可以在1—2个疗程的新辅助治疗后病情缓解，便于手术治疗，从而改善预后。     

局部晚期乳腺癌的治疗进展

新辅助化疗后再手术和（或）放疗已成为治疗局部晚期乳腺癌的治疗模式。本文综述新辅助化疗的依据、疗程方案、影响疗效及预后相关因素及其优缺点，同时介绍了局部晚期乳腺癌诊断，局部治疗及内分泌治疗等方面的进展。     

新辅助化疗在局部晚期乳腺癌治疗中的疗效评价

目的评价新辅助化疗与传统的术后化疗在局部晚期乳腺癌治疗中的效果。方法 2003年10月至2005年10月天水市第一人民医院共收治60例局部晚期乳腺癌患者,30例患者行新辅助化疗,30例患者行术后化疗,对两组患者的手术切除率,5年局部复发率,5年远处转移率,3年及5年生存率,无瘤生存率,治疗前后CEA、CA-153水平等进行比较。结果新辅助化疗组5年局部复发率、5年远处转移率、手术切除率、3年生存率、5年生存率、5年无瘤生存率分别为10.0%、3.3%、96.7%、93.3/%、80.0%及66.6%;传统治疗组则分别为16.7%、10.0%、86.7%、76.7%、70.0%及46.7%,两组相比差异均有统计学意义(均P<0.05)。新辅助化疗组临床痊愈20例,好转4例,恶化6例,治愈率66.7%,好转率13.3%,总有效率80.0%;传统治疗组临床痊愈14例,好转7例,恶化9例,治愈率46.7%,好转率23.3%,总有效率70.0%;两组差异均有统计学意义(均P<0.05)。结论对局部晚期乳腺癌行新辅助化疗的疗效明显优于传统的术后化疗。     

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.     

康莱特对局部晚期乳腺癌新辅助化疗耐受性的影响

[目的]探讨康莱特对局部晚期乳腺癌新辅助化疗耐受性的影响。[方法]60例局部晚期乳腺癌患者分为康莱特组和对照组．两组均行CEF方案化疗,康莱特组同时给予康莱特200ml／d。观察两组骨髓抑制,CD3＋、CD4＋、CD8＋、CD4／CD8及Kamofsky评分变化。[结果]康莱特组和对照组≥3级骨髓抑制发生率分别为13.3％（4／30）、50．0％（15／30）,差异有显著性（P〈0．05）。康莱特组CD3＋、CD4＋、CD4／CD8均显著性高于对照组（P=0．032,P=0．038,P=0．040）。康莱特组生活质量为稳定、减退的患者分别为22、5例,对照组分别为18、10例,两组稳定、减退率均有显著性差异（P=0．044,P=0．030）。[结论]康莱特联合新辅助化疗可以减轻局部晚期乳腺癌患者骨髓抑制．提高免疫功能和化疗耐受性。     

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。     

NE方案新辅助化疗治疗局部晚期乳腺癌的临床疗效分析

局部晚期乳腺癌（locally advanced breast cancer，LABC）一般是指乳腺原发病灶较大，手术切除较困难，但没有远处转移的临床Ⅲ期乳腺癌，其区域淋巴结转移率在90％以上，预后较差，如何有效治疗LABC，是临床上需引起重视的课题之一。术前化疗设计的生物学基础是癌细胞增殖可使耐药性细胞增多，早期采用无交叉耐药的化疗，有助于抑制耐药细胞的产生，从而提高化疗疗效。化疗可以使LABC降期以便手术治疗，而表阿霉素与诺维苯联合应用是目前对转移陛乳腺癌化疗较有效的方案。我中心2003年8月至2004年10月采用表阿霉索加诺维苯作为LABC的新辅助化疗方案，治疗LABC患者46例，观察治疗后肿瘤的有效率、手术切除率及药物的安全性，结果报道如下。     

局部晚期乳腺癌新辅助化疗疗效评价方式的研究进展

局部晚期乳腺癌（locally advanced breast cancer,LABC）预后较差且治疗棘手,而具有独特优势的新辅助化疗（neoadjuvant chemotherapy,NACT）已成为LABC的标准化治疗方式。早期评价NACT疗效可引导临床尽早修正出最适合的化疗方案,并确定手术的最佳时机。因此,NACT疗效的评价手段是当前临床研究的重要问题。当前应用于临床的疗效评价方式包括临床查体、影像学检查、乳腺癌相关标记物及病理学检查。现将LABC患者NACT疗效评价方式作一综述。     

局部晚期乳腺癌新辅助放疗研究进展

乳腺癌发病率居世界女性癌症发病率首位,随着医学技术的进步,乳腺癌患者总生存率得到了提高,但是局部晚期乳腺癌的治疗仍然是棘手的临床问题。对于局部晚期乳腺癌,术后辅助放疗是常规治疗手段,而新辅助放疗在局部晚期乳腺癌治疗中地位尚不明确,本文综述局部晚期乳腺癌新辅助放疗的相关研究进展,希望为局部晚期乳腺癌的治疗提供参考。     

High complete pathological response in locally advanced breast cancer using paclitaxel and cisplatin

Background.In an earlier study, we have demonstrated a high response rate in metastatic breast cancer using paclitaxel (P) and cisplatin (C). A phase II study using the same regimen (PC) has been conducted in locally advanced breast cancer (LABC). Methods.A total of 72 consecutive patients with non-inflammatory LABC (T24cm, T3 or T4, N0–N2, M0). Patients were scheduled to receive 3–4 cycles of the neoadjuvant PC (paclitaxel 135mg/m² and cisplatin 75mg/m² on day 1) every 21 days. Patients were then subjected to surgery and subsequently received 6 cycles of FAC (5-fluorouracil 500mg/m², doxorubicin 50mg/m², and cyclophosphamide 500mg/m²) or 4 cycles of AC (doxorubicin 60mg/m², and cyclophosphamide 600mg/m²). Patients then received radiation therapy, and those with hormone receptor positive tumors were given adjuvant tamoxifen intended for 5 years. Results.The median age was 39 years (range, 24–78). Clinically, 7%, 58%, and 35% of patients had T24cm, T3, and T4, respectively. Disease stage at diagnosis was IIB (33%), IIIA (27%), and IIIB (40%). Complete and partial clinical response to PC was demonstrated in 13 (18%), and 52 (72%) patients, respectively. Of those patients with evaluable pathologic response (68 patients), complete pathologic response (pCR) was achieved in 15 (22%) patients. At a median follow-up of 22 (±3.5) months, 58 (81%) were alive with no recurrence, nine (12%) were alive with evidence of disease, and five (7%) were dead. None of the patients achieving pCR has developed any relapse. The median overall survival has not been reached for all 72 patients with a projected 3-year survival (±SE) of 90% (±4%). The median progression-free survival (PFS) was 42.1 (±4.8) months with a projected PFS of 74%±7% at 3-years (for 68 patients). Conclusions.PC regimen in LABC produced a high pCR. The contribution of the other added modalities to survival could not be assessed.     

Combined sequential approach in locally advanced breast cancer

Background: The interaction between primary and adjuvant chemotherapy is a crucial point in the treatment of locally advanced breast cancer.Objective: To evaluate the therapeutic efficacy of a sequential treatment with primary anthracyclines and adjuvant CMF in this patient subset.Design: Prospective cohort study.Patients: Eighty-eight breast cancer patients, stage T3b-T4 abc, N0–2, M0.Results: From February 1991 to July 1994, 88 consecutive patients with locally advanced breast cancer were treated at the Istituto Nazionale Tumori, Milano, with full-dose doxorubicin (75 mg/m2) or epirubicin (120 mg/m2) for three cycles followed by surgery, adjuvant chemotherapy with i.v. CMF for six cycles and local radiotherapy ± Tamoxifen. A high rate of objective responses (70%), but a low incidence of pathologic complete remission (2%), were observed following primary treatment with single-agent anthracyclines. Frequency of responses was not associated with tumor estrogen or progesterone receptors status, Mib-1 or grading. In 28 patients (32%) conservative surgery could be performed. At a median follow-up of 52 months, relapse free survival and overall survival are 52% and 62%, respectively. A multivariate analysis demonstrated a significant favorable prognosis in patients with limited nodal involvement at surgery and negative Mib-1 values. This drug sequence failed to significantly ameliorate the long term results in this unfavorable patient subset and more effective drug regimens and innovative therapeutic strategies are needed.     

Neoadjuvant chemotherapy in locally advanced breast cancer

Thirty-eight patients with locally advanced breast cancer (Stage III) were treated over a 3-year period. All patients initially received two cycles of CMF (cyclophosphamide, 100 mg/m² p.o. d1–14; methotrexate 40mg/m² intravenously (iv), d1 and d8., 5 Fluorouracil 500 mg/m² iv d1 and d8). They were then subjected to surgery and external beam irradiation to the chest field and drainage areas. Four more cycles of chemotherapy completed the treatment protocol. A response to initial chemotherapy was seen in 75.7% patients, with two patients achieving a complete response. No patient had disease progression while on chemotherapy. Tumor reduction of a degree to allow breast conservation procedures was seen in eight patients. The chemotherapy was well tolerated. Twelve patients failed to complete the treatment protocol. Follow-up for the remaining 26 ranges from 9–40 months (mean 18 months). Ten patients developed a recurrence. Of those, only one had isolated local recurrence, two had local and systemic recurrence, and seven had systemic disease alone. Patients with recurrence were salvaged with further chemotherapy (Adriamycin and cyclophosphamide). © 1996 Wiley-Liss, Inc.     

去甲长春花碱加表柔比星新辅助化疗方案治疗局部晚期乳腺癌的临床研究

目的：了解诺维本加表柔比星(表阿霉素)的联合新辅助化疗方案在局部晚期乳腺癌治疗中的疗效和毒性反应。方法：2001年9月～2003年2月，76例Ⅱb期至Ⅲb期的局部晚期乳腺癌病人入组本次临床试验。入组病例术前接受的新辅助化疗方案为：诺维本25mg／m^2，第1、8天；表阿霉素60mg/m^2，第1天，每三周为1个疗程，共3个疗程。分别观察新辅助化疗后肿瘤原发病灶和区域淋巴结的缓解情况，并观察新辅助化疗的毒性反应。结果：原发病灶临床有效率为84．2％，其中完全缓解(CR)19．7％，部分缓解(PR)64．5％，疾病稳定(SD)14．5％，疾病进展(PD)1．3％；病理完全缓解率为14．5％(11／76)。32例化疗前细针穿刺活检明确区域淋巴结转移阳性的病人中，9例(28．1％)术后病理腋淋巴结转移阴性。毒性反应主要为白细胞减少症、脱发和恶心／呕吐，共有39例(54．2％)病人发生了Ⅲ到Ⅳ度的白细胞减少症，但未有因此而发生的败血症和死亡病例。结论：诺维本加表阿霉素的新辅助化疗方案在局部晚期乳腺癌的治疗中疗效显著，耐受性良好。     

局部进展期乳腺癌新辅助化疗前后生物标志物表达变化与疗效的相关性

目的：探讨局部进展期乳腺癌行新辅助化疗前后相关生物标志物的表达变化情况与化疗疗效的相关性。方法：采用免疫组化方法检测102例新辅助化疗前后局部进展期乳腺癌组织中雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体－2（HER －2）、p53和增殖细胞核抗原（Ki －67）等表达,分析化疗前后生物标志物表达变化与化疗疗效的相关性。结果：ER 阴性组、PR 阴性组、Ki －67高表达组的新辅助化疗有效率分别为50．0％、49．1％、51．4％,高于 ER 阳性组26．0％、PR 阳性组25．5％、Ki －67低表达组9．4％（P ＜0．05）。Logistic 多因素回归分析显示,ER、Ki －67的表达水平是评估化疗疗效的独立因素（P ＜0．05）。Luminal 型乳腺癌总生存期高于 non －Luminal 型（Long －rank 检验,P ＜0．05）。结论：ER、Ki －67、分子亚型可作为局部进展期乳腺癌新辅助化疗疗效判断的重要预测指标。     

Randomized trial comparing neo-adjuvant versus adjuvant chemotherapy in operable locally advanced breast cancer (T4b N0-2 M0)

BACKGROUND AND OBJECTIVES: Locally advanced breast cancer (LABC) remains a major problem in developing countries. While trials utilizing neo-adjuvant chemotherapy demonstrate superior survival rates compared to historic controls, randomized studies evaluating the precise role of neo-adjuvant chemotherapy in LABC are lacking. In the present trial, neo-adjuvant chemotherapy was compared against adjuvant chemotherapy to assess survival advantage in operable T4b N0-2 M0 breast cancer. METHODS: A total of 101 women with operable LABC (T4b N0-2 M0) were randomized. In arm A, 50 patients received 3 cycles of CEF chemotherapy before and 3 cycles following surgery. In arm B, 51 patients had primary surgery followed by 6 cycles of CEF chemotherapy. In both arms, loco-regional radiotherapy was given after completion of CEF. RESULTS: The response of primary tumor to neo-adjuvant chemotherapy was 66%, complete response (CR) 14% and partial response (PR) 52%. Clinical nodal response occurred in 95% of node positive patients. Only two (4%) patients had pathologic CR both in tumor and axilla. There was a significant (P = 0.02) increase in incidence of pathologically negative nodes in arm A. At a median follow up of 25 months, there was no significant difference in overall and disease free survival (DFS) in both arms (P = 0.42 and 0.18). Patients showing a response to neo-adjuvant chemotherapy had better DFS (P = 0.04) compared to those who had no response. CONCLUSIONS: Early results of the study indicate no survival benefit with the inclusion of neo-adjuvant chemotherapy in LABC (T4b N0-2 M0). Neo-adjuvant chemotherapy resulted in significant down staging; good responders had a better DFS compared to those who did not respond.