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.     

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。     

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。     

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…     

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的临床应用

 目的 探讨局部晚期乳腺癌术前化疗的临床意义和价值。方法 对66例局部晚期乳腺癌采用新辅助化疗CAF（或CEF）方案，共3 ~ 4个周期，分别测量化疗前、后肿瘤大小的变化，评价疗效。择期行根治手术或保乳手术、局部根治性放疗，术后个体化综合治疗。结果 新辅助化疗后66例中临床完全缓解（CR）4例，部分缓解（PR）43例，无效（NC）18例，进展（PD）1例，总有效（CR+PR）率71.06 %。未发生严重毒副反应。结论 局部晚期乳腺癌新辅助化疗具有降低肿瘤分期，增加根治和保乳手术机会，指导术后化疗方案选择，消灭全身亚临床转移病灶，提示病情预后，提高5年生存率的临床意义。     

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。     

新辅助化疗联合手术治疗局部晚期乳腺癌的疗效观察

目的探讨新辅助化疗联合手术治疗局部晚期乳腺癌的临床疗效及对患者生活质量的影响。方法选取2013年12月至2014年12月间河南省内乡县人民医院收治的150例局部晚期乳腺癌住院患者作为研究对象,根据采用的治疗方法不同分为两组,手术治疗前后分别行3个周期化疗的80例患者纳入观察组,手术治疗后行6个周期化疗的70例患者纳入对照组。比较两组患者的近期疗效、远期疗效、生活质量及不良反应情况。结果入院时,两组患者的癌胚抗原(CEA)和糖类抗原153(CA-153)水平比较,差异无统计学意义(P> 0. 05)。化疗后,两组患者CEA和CA-153水平均显著降低,且观察组的CEA和CA-153水平均显著低于对照组,差异均有统计学意义(均P <0. 05)。观察组患者治疗总有效率为75. 0%,高于对照组患者的42. 9%,差异有统计学意义(P <0. 05)。两组患者1年生存率、3年生存率、局部复发率和远处转移率比较,差异均无统计学意义(P> 0. 05)。治疗前,两组患者的总体健康和总体生活质量评分比较,差异无统计学意义(P>0. 05)。治疗后,两组患者半年和1年的总体健康和总体生活质量评分均显著提高,且观察组半年和1年的总体健康和总体生活质量评分均显著高于对照组,差异均有统计学意义(均P <0. 05)。结论新辅助化疗联合手术治疗局部晚期乳腺癌能够有效提高近期疗效,改善患者的生活质量,但对远期疗效的改善效果并不显著。     

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。     

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.     

局部晚期宫颈癌术前新辅助化疗的应用价值

目的 评价新辅助化疗对于局部晚期宫颈癌的术前疗效和手术效果.方法新辅助化疗组32例局部晚期宫颈癌术前进行2个周期的TP方案化疗,化疗结束后2-3周行广泛全子宫切除加盆腔淋巴结清扫术,并以同期相同条件的直接手术的32例局部晚期宫颈癌作为对照,观察化疗前后肿瘤大小、SCC值的变化和化疗毒副反应,并对两组手术情况和术后病理进...     

局部晚期宫颈癌53例新辅助化疗的疗效观察

目的探讨紫杉醇联合卡铂方案的新辅助化疗（NACT）对局部晚期宫颈癌（LACC）的近期疗效和毒副反应。方法NACT组53例LACC患者术前行紫杉醇联合卡铂方案的NACT,化疗结束3周后行子宫根治性手术;而对照组47例LACC患者仅常规术前准备后行子宫根治性手术。观察NACT组的化疗疗效和毒副反应以及2组的手术情况。结果NACT组化疗有效率为83．02％,且毒副反应较轻。NACT组的术后脉管瘤栓阳性率、切缘阳性率、淋巴结转移率、并发症发生率及复发率均低于对照组,差异均有统计学意义（P均〈0．05）。结论紫杉醇联合卡铂方案的NACT对LACC近期疗效好,有利于手术的顺利进行,且手术预后也较好。     

Predicting Response to Neoadjuvant Chemotherapy Using 18F FDG PET-CT in Patients with Locally Advanced Breast Cancer

Objective: The study was aimed to find the utility of 18F FDG PET CT in assessing response to neoadjuvant chemotherapy (NACT) in female patients with locally advanced breast cancer (LABC). Methods: All willing women with biopsy proven LABC, following clinical evaluation underwent baseline 18F FDG PET CT along with mammosonograpy and contrast enhanced computerized chest radiography (CECT). The response was assessed clinically before each cycle of chemotherapy using RECIST criteria. Those who were progressing clinically were offered alternate chemotherapy or radiation or surgery. Clinical responders were re-evaluated with 18F FDG PET CT, mammosonogram and CT chest before surgery. The pathological response as assed with residual cancer burden score was used as gold standard. Results: Of the 30 women eligible, 26 women underwent repeat evaluation and surgery. The mean age was 49 years, 16 women were postmenopausal and 15 tumors were receptor positive. On final histopathology 15 % had completer response and 46 % were non responders. Using a cut off value of 50% of the baseline SUVmax, PET-CT had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 64%, 75%, 75%, 65%, and 69%, respectively in differentiating pathological responders from non-responders. Conclusion: 18F FDG PET-CT predicted the response with greater accuracy than CT or clinical examination. Hence it can be used to identify non responders early in the course and alternate treatment can be offered to patients.     

Neoadjuvant Intra-arterial Chemotherapy in Locally Advanced Breast Cancer: A Prospective Randomized Study

A prospective randomized study of neoadjuvant chemotherapy wascarried out on 73 patients with locally advanced breast cancer.Group A (n 26) received no neoadjuvant therapy, group B (n 22)received intra-arterial infusions of epirubicin and group C(n 25) received intravenous epirubicin. The regression of theprimary tumor was significantly higher in group B than in groupC (68.2 vs 36.0%, P<0.05). The post-operative survival ofresponders to neoadjuvant therapy was better than that of non-responders.Side effects were milder in group B than in group C. There was,however, no difference among the three groups in terms of overalland disease-free survivals. Thus, neoadjuvant intra-arterialchemotherapy was effective for achieving loco-regional controlof locally advanced breast cancer with a low toxicity, but couldnot improve survival.     

Response to Neoadjuvant Chemotherapy in Patients with Advanced Breast Cancer: A Local Hospital Experience

A large proportion of women present with advanced breast cancer in the developing countries with limitedresources. Many of these patients have ulcerated, bleeding lesions or visually obvious masses in the breast.Neoadjuvant chemotherapy is well established as the standard of care and initial management of choice forthese patients. Tumor shrinkage achieved with neoadjuvant chemotherapy has the advantage of converting aninoperable disease to an operable condition, with the option of breast conservation surgery where mastectomyis the only initial option for loco-regional control. Neoadjuvant chemotherapy also provides the earliest possibletreatment of micrometastases and thus improves survival. In the present study, 165 advanced breast cancerfemale patients registered at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, between 1st July2005 and 30th June 2007 were evaluated for response to neoadjuvant chemotherapy. Tumor measurements weremade and recorded prior to the first cycle of chemotherapy and 3 weeks after the third cycle. A clinical completeresponse was seen in 7.3%, a partial response in 60%, stable disease in 24% and progressive disease in 9%. Acomplete pathological response was only seen in 3.6% of evaluable patients. We conclude that breast cancer inpatients presenting for neoadjuvant chemotherapy at our facility is more aggressive, generally presents as moreadvanced and bulky local disease, affects a younger population and features a low and unpredictable responseto neoadjuvant chemotherapy.     

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.     

Locally Advanced Breast Cancer in Jamaica: Prevalence,Disease Characteristics and Response to Preoperative Therapy

Breast cancer is the most common cancer in Jamaican women. Locally advanced breast cancer (LABC) isassociated with aggressive biology and poor prognosis, and has a predilection for African-American women. Inthis retrospective review, we assessed the prevalence of LABC as a breast cancer presentation in a population ofmainly Afro-centric ethnicity, and determined disease characteristics and response to pre-operative chemotherapy.LABC was prevalent (20%), and had a low pathological response rate to pre-operative chemotherapy, with ahigh risk of disease recurrence. Increased utilization of breast cancer screening may help detect cancer at lessadvanced stages, and optimizing pre-operative chemotherapy is recommended to improve response rates andultimately survival.