Ⅲ期晚乳腺癌术前动脉内灌注化疗的临床研究

1972年 8月至 1999年 12月 ,我科对 76例女性Ⅲ期晚乳腺癌以腋动脉灌注化疗作为术前的诱导治疗 ,取得良好效果。现报告如下。临床资料1.一般资料 :本组 76例均为病理证实的Ⅲ期晚乳腺癌女性患者 ,Ⅲａ 期 46例 ,Ⅲｂ 期 2 2例 ,Ⅳ期 8例。年龄 2 6～ 78岁 ,平均 46 2岁。肿瘤长径 16例 10～ 2 0ｃｍ(平均 13 6ｃｍ) ;5 7例 5 1～ 9 9ｃｍ。 3例为乳腺癌外院术后乳腺区域有单个复发灶 (小于 5ｃｍ)。本组有 12例皮肤桔皮样变 ;6例皮肤溃烂 ;,2例有卫星结节 ;8例胸大肌受侵犯 ,活动性差 ;70例同侧腋窝可扪及肿大的淋巴结。 37例病史 1年以上…     

可手术的Ⅲ期乳腺癌术前化疗疗效分析

我科从 1999年 4月～ 2 0 0 4年 5月应用术前化疗疗法治疗Ⅲ期乳腺癌 3 2例 ,收到了较为满意的效果 ,现报告如下 :1　临床资料1.1　一般资料 :本组均为女性 ,年龄 2 5～ 68岁 ,平均 5 2 .8岁。治疗前常规检查肝肾功能、胸透、B超及其他器官均无器质性病变 ,无远处转移者。治疗前肿块针吸细胞学诊断者 2 6例 ,活检针组织病理诊断 6例。术后切除标本经病理证实均为乳腺癌 ,其中 1例为双侧乳腺癌。1.2　化疗方案 :FAC方案 :环磷酰胺针 5 0 0mg/m2 静注 ,表阿霉素 60～ 70mg/m2 (或阿霉素针 40mg/m2 ) ,氟脲嘧啶针 5 0 0mg静滴5天 ,2 1天为一…     

Ⅲ期乳腺癌术前新辅助化疗的临床观察

目的　研究Ⅲ期乳腺癌术前新辅助化疗的临床效果。方法　 1999年～ 2 0 0 1年 6月住院手术治疗的Ш期乳腺癌患者 62例 ,术前行辅助化疗 ,回顾分析 1997～ 1998年间收治的 3 7例Ш期乳腺癌未作辅助化疗而直接手术作为对照组。从手术切除后病理切片观察细胞变化及术后局部复发 ,远处转移等方面进行比较。结果　手术后病理切片观察癌细胞坏死情况 ,新辅助化疗组有效率为 67.7% ,而对照组仅 6例癌细胞有轻度局灶坏死。术后三年局部复发或远处转移新辅助化疗组为 11.4% ,对照组 2 4.3 %。结论　手术前辅助化疗能大量杀伤肿瘤细胞 ,缩小肿瘤便于手术 ,减少远处播散机会     

Ⅲ期乳腺癌区域化疗后手术近期肝转移1例

1　病历资料患者 ,女性 ,3 2岁。发现左乳腺肿物、迅速增大半年伴乳头溃烂。查体 :双侧乳房不对称 ,左乳房明显肿大 ,皮肤暗红色 ,可见一梨形大小肿物位于乳头下方 ,牵拉乳头内陷 ,乳头表面溃烂 ,并溢血水 ;乳晕周围皮肤色素沉着明显 ,呈“桔皮样”。肿物约 16cm× 11cm× 8cm ,表面不光滑 ,质硬 ,边缘尚清晰。肿物未侵及胸壁 ,可移动 ,轻触压痛。双锁骨上、胸骨旁及右腋窝淋巴结均不肿大 ,左腋窝触及核桃大团块状肿大淋巴结。实验室检查 :血常规、肝功能正常 ,碱性磷酸酶3 5IU L ,肌酸激酶 2 10IU L ,乳酸脱氢酶 3 17IU L ,羟丁酸脱氢…     

局部晚期乳腺癌经尺动脉插管灌注化疗的观察与护理

目的探讨和总结局部晚期乳腺癌经尺动脉插管灌注化疗的护理问题和护理措施。方法对45例局部晚期乳腺癌经尺动脉插管灌注化疗的患者实施心理护理、灌注护理及灌注术后护理。结果经灌注化疗后，乳腺癌局部肿块缩小变软，腋窝淋巴结缩小甚至消失，锁骨上肿大淋巴结缩小，无严重并发症发生。结论完善、缜密的护理措施为实施局部晚期乳腺癌经尺动脉插管灌注化疗提供了有利的保证，使治疗达到满意的临床效果。     

乳腺癌术前化疗的作用

(摘自2001年5月美国旧金山ASCO会议) 1 术前化疗 对可手术乳腺癌患者术前化疗(新辅助化疗)的概念已涉及到临床以及对肿瘤细胞的研究,通过术前化疗使局部肿瘤缩小,增加了保留乳腺手术的比例,同时腋窝病理检查由阳性转为阴性的比例增加.现在已从强调手术作为乳腺癌的唯一治疗发展到强调全身治疗,因此,对这个领域的研究具有理论和实践意义.     

胃癌术前行选择性动脉插管灌注抗癌药物治疗与一般化疗的疗效比较

本文对３３例经病理组织学确诊为胃癌的病人于手术前行选择性动脉插管灌注抗癌药物治疗并与同期１０例胃癌病人于术前行全身静脉化疗相比，取得近期满意疗效。在治疗组中，除临床症状有不同程度的外，其胃癌原发灶和淋巴结转移灶中，癌细胞均有不同程度的变性坏死。     

可手术的Ⅲ期乳腺癌综合治疗模式的研究

可手术的Ⅲ期乳腺癌综合治疗模式的研究铁道部北京总医院（１０００３８）崔永旺杜伟生马庆莲临床对Ⅰ、Ⅱ期乳腺癌施行功能保全手术已取得可喜疗效。但在我国临床上，中晚期乳腺癌的疗效尚不尽人意。本文就可手术的Ⅲ期乳腺癌的治疗方法进行研究，报告如下。１材料与方法...     

Neoadjuvant chemotherapy in stage III breast cancer

Neoadjuvant chemotherapy in advanced breast cancer can potentially downstage disease prior to definitive surgery. In this study, a doxorubicin-based neoadjuvant regimen was administered to stage III breast cancer patients to assess 1) primary tumor response, 2) tumor involvement of resection margins, and 3) predictive value in cancer outcome. Eighty-two patients with stage IIIA and IIIB breast cancer diagnosed between 1990 and 2003 were studied. All patients received similar chemotherapy regimens, consisting of doxorubicin, cisplatin, and 5-fluorouracil, plus surgery and radiation therapy. End points measured include primary tumor response [complete response (CR) = 100%, partial response (PR) > 50%, or no response (NR) < or = 50%], resection margins for tumor, disease-free, and overall survival. Kaplan-Meier and log-rank tests were performed. Of the 82 patients studied, 34 received neoadjuvant therapy, 48 received conventional postoperative treatment. Seventy-two per cent of the stage IIIB and 22 per cent of the stage IIIA patients received neoadjuvant therapy. In the neoadjuvant group, 29 (85%) patients demonstrated tumor response, 9 (26%) of which were CR. Tumor-free resection margins were achieved in 94 per cent of the neoadjuvant group. Survival analysis demonstrated no benefit comparing neoadjuvant versus postoperative adjuvant therapy but hints at improved disease-free survival in neoadjuvant CR patients (log-rank test, P = 0.07). Eighty-five per cent of patients with stage III breast cancer treated with neoadjuvant chemotherapy experienced clinical response, with 26 per cent CR, and 97 per cent tumor-free resection margins. CR may portend a better cancer outcome.     

Tamoxifen versus chemotherapy as adjuvant treatment in stage III breast cancer

A randomized prospective trial was conducted to compare Tamoxifen and combination chemotherapy (5-fluorouracil, doxorubicin and cyclophosphamide) as adjuvant treatment for patients with locally advanced (Stage III) breast cancer. At the end of 5 years, no significant difference could be found in the disease-free period for both groups.     

局部晚期乳腺癌术前介入化疗近期疗效观察

【摘要】目的评价术前介入化疗治疗局部晚期乳腺癌的近期疗效。方法选取我科2010年2月至2016年1月期间经空心针穿刺活检病理证实的局部晚期乳腺癌患者共13例,全部采用Seldinger’s方法,局麻后经股动脉穿刺,将导管选择至肿瘤主要供血动脉,灌注化疗药物,方案为法玛新100 mg,丝裂霉素10 mg,氟尿嘧啶1000 mg,奥沙利铂150 mg,随后选择性栓塞供血动脉。结果CR2例,PR10例,SD1例,有效率（CR+PR）为92.3%,患者获益率（CR+PR+SD）为100%。13例患者均获得根治性切除。结论术前介入化疗是提高局部晚期乳腺癌手术切除率有效安全的方法。     

Assessment of response to preoperative chemotherapy in patients with stage II and III breast cancer: the value of MRI

The response to preoperative chemotherapy in breast cancer was assessed by magnetic resonance imaging (MRI), and compared to the histological and clinical findings.Forty-two patients with stage II and III breast carcinoma were evaluated prospectively prior to and after preoperative chemotherapy by MRI, clinical and histological examination. Radiological response was assessed using the MRI parameters: total tumor volume (TTV), maximum enhancement index (MEI) and their product (TTV^*MEI).A significant reduction in all MRI parameters was observed after chemotherapy. Overall clinical and radiological response rates were comparable (69% vs 73%). MRI was not useful for the prediction of complete pathologic response. A fair correlation between TTV postchemotherapy and final histological diameter was found. A significant difference of residual TTV for patients undergoing breast conservative surgery vs mastectomy was observed.Conclusion: MRI can demonstrate responses induced by preoperative chemotherapy in breast cancer, but it cannot determine complete pathologic responses.     

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目的 探讨临床Ⅰ、Ⅱ期乳腺癌术前短程化疗的意义。方法 122例临床Ⅰ、Ⅱ期乳腺癌术前用CEF方案化疗1疗程，化疗后3-5d手术。结果 部分缓解21例(占17．2％)，轻度缓解76例(占62．3％)，无变化25例(占20．5％)，无临床进展病例。术前可扪及腋窝肿大淋巴结42例，化疗后30例见淋巴结明显缩小或消失。病理组织学观察75例镜下见肿瘤细胞有小点片状坏死。106例按计划手术；16例因白细胞降低等化疗反应推迟手术。全组随访1～6年，无局部复发病例；6例在随访期间1～3年内发现骨转移，经放疗和化疗控制；仅1例同时有骨转移和肺转移者于术后4年死亡；余均健在。结论 可手术乳腺癌的术前短程化疗可观察到肿瘤缩小等治疗效果，为术后化疗提供指导。并可能减少术中血行转移和提高疗效。     

Neoadjuvant chemotherapy before definitive treatment for stage III carcinoma of the breast

One hundred women with American Joint Committee (AJC) stage III (T2, N2; T3, N0/1/2; T4, N0/1/2) carcinoma of the breast were treated with combination chemotherapy following biopsy to confirm the diagnosis and determine hormone receptor status before any other treatment of the local disease (so-called neoadjuvant chemotherapy). Response was assessed after three cycles of treatment, and responders were treated until the tumor and/or axillary nodes failed to show further regression. Definitive surgery was then performed, usually radical mastectomy. Chemotherapy was resumed following surgery for a total of 12 cycles. Ninety patients are assessable, and 70% have responded to chemotherapy. Outcomes of both responders and nonresponders were analyzed. Radical mastectomy without postoperative radiotherapy seems to be the preferable surgical treatment for the responders. Median follow-up of the assessable patients was 27 months; projected five-year disease-free survival of the responders is greater than 65%, and projected overall five-year survival of this group is greater than 85%. Because the follow-up of these patients suggests a marked improvement in outcome compared with similar patients treated traditionally with mastectomy or radiotherapy followed by adjuvant chemotherapy, we advocate more widespread use of combination chemotherapy before definitive treatment for stage III carcinomas of the breast.     

The dilemma of stage III breast cancer: a study of preoperative radiotherapy.

The results of treatment of 68 patients with Stage III breast cancer treated by preoperative radiotherapy and subsequent mastectomy have been compared with those in 68 patients treated by more conventional methods, matched individually for age, stage, and year of treatment. Preoperative radiotherapy delayed the time of the first local recurrence, but did not improve overall survival. It is concluded that preoperative radiotherapy may be justified in patients with Stage III breast cancer in an attempt to control local disease, but is unlikely to improve control of systemic recurrence.     

新辅助化疗及保乳手术在Ⅱ|Ⅲ期乳腺癌中的治疗作用

目的探讨新辅助化疗及保乳手术在Ⅱ,Ⅲ期乳腺癌治疗中的作用。方法对观察组46例Ⅱ,Ⅲ期乳腺癌经新辅助化疗后接受保乳手术治疗的患者进行随访观察,并与59例患者对照研究。新辅助化疗方案为表阿霉素60 mg/m2第1天静脉注射,紫杉醇150 mg/m2。第2天持续3 h静脉滴注,21 d为1个疗程。保乳手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清除。对照组常规行根治性切除术。术后对乳房外形及局部复发、远处转移进行随访观察。结果新辅助化疗后,观察组术前肿瘤病灶临床完全缓解(CR)9例,部分缓解(PR)37例。术后病理学检查发现,观察组癌细胞均有不同程度的变性、坏死,细胞间质水肿,纤维增生,炎性细胞浸润;其中病理完全缓解(PCR)4例。对保乳综合治疗(放疗+化疗)结束后1年的31例患者进行外形评估,其中优19.4%(6/31),良58.1%(18/31),差22.6%(7/31)。观察组局部复发率为8.7%(4/46),对照组为6.8%(4/59),两组比较无统计学意义(P0.05);观察组远处转移率为6.5%(3/46),与对照组(15.3%,9/59)比较无统计学意义(P0.05)。结论新辅助化疗后行保乳手术治疗Ⅱ,Ⅲ期乳腺癌基本是安全的,可达到根治性手术的效果。新辅助化疗,规范化切除,术后放疗、化疗是保乳治疗成功的关键。     

Evaluation of the effect of ovariectomy in patients with stage III breast cancer

The efficiency of prophylactic ovariectomy and hormone treatment with corticosteroids in patients with primary III degree breast carcinoma was studied. The indices of actuarial survival in the group of patients subjected to ovariectomy (n-115) during the follow-up period from 4 to 15 years proved to be reliably higher (p less than 0.05) as compared with controls (n-145). In determining the upper age limit of the susceptibility to ovariectomy it is expedient to take into consideration the menstrual status: in women it should be performed in premenopause or in the menopause not longer than 5 years.