乳腺癌的新辅助化疗

新辅助化疗是指对非转移性肿瘤在应用局部治疗前进行的全身性的、系统性的细胞毒性药物治疗,目前已成为乳腺癌治疗标准中的重要组成部分。由于各种文献报道中对新辅助化疗的描述的角度不同,这种肿瘤治疗的方式又曾分别被称为术前化疗、首次化疗和诱导化疗。在乳腺癌中,其主要目的在于:①对不适用手术的局部晚期乳腺癌患者降低分期,使手术成为可能;②对部分可手术的早期乳腺癌患者提高保乳手术的可能性和成功率;③获得早期的肿瘤生物学特性及对化疗药物的敏感性资料。     

影像技术在预测乳腺癌新辅助化疗疗效中的应用进展

乳腺癌是我国女性最常见的恶性肿瘤之一。术前新辅助化疗现已成为乳腺癌的一种规范化治疗方案,局部晚期乳腺癌和特殊亚型早期乳腺癌的患者可在其中获益。但乳腺癌的肿瘤异质性和患者的个体化差异影响了新辅助化疗的效果,只有不到30%的患者在接受新辅助化疗时达到病理完全缓解,早期预测乳腺癌对新辅助化疗的反应可以避免患者过度化疗,因此正确、无创的影像学评估对后续治疗规划至关重要。本文就当前影像技术及其人工智能在乳腺癌新辅助化疗中的应用和进展作一系统综述。     

新辅助化疗对乳腺癌患者术后存活率的影响

乳腺癌近年来发病率越来越高,在恶性肿瘤中占到7％～10％［1］,据相关报道［2］,早期乳腺癌患者采取新辅助化疗的治疗有效率可达70％～90％,并且能够明显增加保乳手术机会。晚期乳腺癌患者采取新辅助化疗能够降低分期,同时提高手术切除率。本研究主要观察新辅助化疗对乳腺癌术后存活率的影响,现报告如下。     

乳腺癌新辅助化疗后局部病灶的外科处理原则

新辅助化疗是局部晚期乳腺癌标准治疗方案中的重要组成部分之一.可提高肿瘤切除率与保乳率.对于早期乳腺癌,新辅助化疗可使原发肿瘤降期以提高局部切除的可行性,并可早期评价化疗敏感性从而指导个体化治疗.一些研究已经证实新辅助化疗的反应与患者生存率相关,许多患者将得益于其对远处器官内微小转移灶的控制.本文将就新辅助化疗后保乳的选择、乳房再造术的时机以及区域淋巴结治疗等局部病灶外科处理的研究进展作一综述.1)新辅助化疗后的保乳手术不应为追求保乳而以降低生存率或增加局部复发为代价,且选择标准应与直接手术相一致,存在局部晚期病变但对化疗反应好的患者也考虑保乳手术.2)新辅助化疗后的晚期乳腺癌患者行即刻乳房再造术,其并发症发生率并无增加;但放疗可导致假体再造乳房的包膜挛缩或反复感染,对自体乳房再造的影响尚无定论.因此局部晚期乳腺癌患者应考虑行延迟乳房再造术;Kronowitz等人提出的"延迟一即刻"乳房再造是一种具有实用价值的方法.3)对新辅助化疗敏感的患者可考虑通过前哨淋巴结活检进行腋窝淋巴结分期;在新辅助化疗前后行活检各有利弊.一些研究中将超声和前哨淋巴结活检相结合来判断腋窝淋巴结状态的方法值得借鉴,但尚需更多的研究加以证实.     

乳腺癌化疗进展

乳腺癌是一种全身性疾病 ,往往在病变的早期即可能发生远处转移。当今乳腺癌治疗的观念从单一的外科手术治疗转变为全身的综合治疗。目前治疗乳腺癌的趋势是手术范围越来越小 ,采用小手术大放疗的方法 ,达到保留乳房美观的作用 ;通过采用术前新辅助化疗 ,使手术适应证越来越宽 ,全身性治疗手段越来越被重视 ,化疗及内分泌治疗占有越来越重要的地位 ;基因治疗进入临床 ,使乳腺癌的治疗展现了广阔的前景。１新辅助化疗（Ｎｅｏ ａｄｊｕｖａｎｔｃｈｅｍｏｔｈｅｒａｐｙ）新辅助化疗即手术或放疗前先给予化学治疗。它除了与术后辅助化疗一样…     

乳腺癌新辅助化疗研究进展

随着对乳腺癌是一种全身性疾病的认识转变，乳腺癌的治疗重点亦从以往的手术治疗转向早期全身治疗的新模式，其中最重要的是新辅助化疗（neo—adjuvant chemotherapy，NCT）。一些大规模的临床试验也肯定了新辅助化疗在乳腺癌全身性综合治疗方面的价值。由于新辅助化疗实践的不断深入，对乳腺癌从基础到临床各方面有了更新的认识。     

乳腺癌新辅助化疗的临床评价方法解析

乳腺癌新辅助化疗(NAC)最初是指对局部晚期乳腺癌患者手术治疗之前所进行的辅助化疗,目前己将该治疗扩展至肿瘤较大的可手术的乳腺癌患者,以使肿瘤降期,进而达到保乳手术治疗的目的.随着新辅助化疗在乳腺癌患者中不断推广应用,使用传统方法和影像学评价预测新辅助化疗反应,未能提供准确和可靠的数据.因此临床实践中迫切需要一种能准确评价化疗后肿瘤变化的检查方法.最近,光散射断层成像,新的生物标志物,癌基因组分析引入到临床实践,产生了初步可喜的成果.本文对乳腺癌新辅助化疗的临床评价方法进行综述.     

剂量密集新辅助化疗治疗乳腺癌的研究进展

剂量密集辅助化疗能够改善早期高危乳腺癌患者的远期生存,同时缩短了治疗时间,是乳腺癌辅助化疗的重要选择.新辅助化疗是局部晚期乳腺癌的标准治疗方式,也是乳腺癌综合治疗的重要组成部分,近年来剂量密集化疗在新辅助化疗领域也进行了探索及研究.本文综述了剂量密集新辅助化疗治疗乳腺癌的文献报道,分析不同剂量密集新辅助化疗方案的疗效、...     

绝经后雌激素受体阳性乳腺癌患者的新辅助内分泌治疗

局部晚期乳腺癌(locally advanced breast cancer,LABC)及肿瘤较大的可手术乳腺癌,采用新辅助化疗,可使肿瘤缩小,分期降级,易于手术,外科治疗效果得到明显改善.但对年老体弱或伴有其他重要疾病、不能耐受化疗的患者不能采用新辅助化疗.     

新辅助化疗对乳腺癌手术方式的影响

新辅助化疗除了可以缩小乳腺肿瘤病灶,进而减少外科手术切除范围外,部分患者还可通过新辅助化疗达到原发灶和腋窝淋巴结转移病灶的pCR。对于这部分降期和pCR的乳腺癌患者,经过新辅助化疗后,如何更加合理的选择外科手术方式是临床医师常常面对的难题。因此,笔者回顾性分析新辅助化疗相应的临床研究,就新辅助化疗对乳腺癌患者手术方式的影响进行综述。     

Neoadjuvant chemotherapy for operable breast cancer

Adjuvant systemic chemotherapy has been shown to prolong survival in all subsets of patients with breast cancer. In addition, among patients with locally advanced breast cancer, neoadjuvant orpreoperative chemotherapy has improved the ability to perform breast-conserving therapy. This observation, combined with multiple preclinical hypotheses and the results of laboratory studies, has prompted investigation of neoadjuvant chemotherapy as a treatment strategy for operable breast cancer. In this article, both the evidence supporting this treatment approach and some of the problems associated with it are reviewed. Currently, seven randomized studies comparing neoadjuvant chemotherapy followed by surgery or surgery followed, in turn, by adjuvant chemotherapy have been completed and their results analyzed. Despite exciting preclinical evidence, no trial to date has shown a survival advantage for the neoadjuvant treatment approach. Nonetheless, evidence from more recent phase III trials and the fact that neoadjuvant chemotherapy is not harmful topatients validate its use in operable breast cancer.     

乳腺癌新辅助化疗10年预后的影响因素分析

目的:分析乳腺癌新辅助化疗患者的预后及影响因素。方法:回顾性分析302例乳腺癌新辅助化疗患者的临床资料,进行单因素和多因素分析影响预后的因素。结果:全组患者10年生存率为70.5%。多因素分析表明,新辅助化疗的近期疗效、是否三苯氧胺治疗、腋窝淋巴结临床及病理分期与患者的10年生存期有关。结论:新辅助化疗的近期疗效、是否三苯氧胺治疗、腋窝淋巴结临床及病理分期是影响乳腺癌新辅助化疗患者10年预后的独立因素。     

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。     

Current and future roles of neoadjuvant chemotherapy in operable breast cancer

Neoadjuvant chemotherapy was initially used only as treatment for locally advanced breast cancer. However, because breast cancer is considered to be a systemic disease in which distant micrometastases are already present at the time of the initial diagnosis, primary systemic therapy may be beneficial in the eradication of these micrometastatic lesions. Despite the fact that no survival benefit of neoadjuvant chemotherapy over adjuvant chemotherapy has yet been demonstrated, the clinical indication for neoadjuvant chemotherapy is being extended not only to stage T3/4 tumors but also to some stage T1/2 operable breast cancers. The current clinical benefits of the use of neoadjuvant chemotherapy are that (1) the safety of neoadjuvant chemotherapy is comparable with that of adjuvant chemotherapy, (2) neoadjuvant chemotherapy increases the possibility of the use of breast-conserving surgery, and (3) pathologic complete response may be a predictive indicator of better survival. Importantly, the response to neoadjuvant chemotherapy in vivo could provide a useful prediction of prognosis and help define strategies for an individual patient's future treatment with alternative chemotherapy regimens or molecular-targeting agents. Furthermore, the discovery of predictive markers for tumor response to neoadjuvant chemotherapy through the analysis of complementary DNA microarrays and proteomics may also help facilitate individualized chemotherapy, particularly by improving survival in patients with breast cancer with a poor prognosis. Herein we review the current status and future role of neoadjuvant chemotherapy in operable breast cancer in terms of its survival benefit and the potential for the individualization of adjuvant therapy for these patients.     

Neoadjuvant taxanes in the treatment of non-metastatic breast cancer: a systematic review

In recent years the role of neoadjuvant (primary, preoperative) chemotherapy has undergone rapid progress. Initially, neoadjuvant chemotherapy use was limited to those patients with inoperable locally advanced breast cancer in an attempt to try to down-size the tumour to make effective surgery possible. The advent of more effective chemotherapy regimens has led to an increased use of neoadjuvant therapy to shrink potentially operable tumours to allow for breast conservation when a mastectomy would have been required previously. While neoadjuvant treatment for operable tumours has indeed allowed increased rates of breast conserving surgery, it has not yet demonstrated any survival benefit over standard postoperative anthracycline-based chemotherapy. Echoing the evolution of taxane based chemotherapy from the metastatic setting through to the adjuvant situation, there has been increased interest in the role of taxanes in neoadjuvant regimens. The use of taxane-based therapies in this setting has so far shown improvements over more standard regimens in terms of clinical response rates, breast conservation, pathologic response rates, disease free survival, and overall survival. The aim of this review is to systematically summarize and interpret the results of published randomized controlled trials of neoadjuvant taxane chemotherapy for women with non-metastatic breast cancer.     

Surgical Considerations Following Preoperative Systemic Chemotherapy

The indications of neoadjuvant chemotherapy for breast cancer are extending to a larger population of breast cancer patients. The aims of this therapy are to transform the cancer to an operable form, downsize the tumor volume to allow a lumpectomy instead of a mastectomy, or to perform an in vivo test of the effect of the treatment on breast cancer in a specific individual. Along with these benefits, there is concern about the safety of lumpectomy and sentinel lymph node biopsy after neoadjuvant chemotherapy. In this review, we discuss the experience of breast conservation therapy after neoadjuvant chemotherapy and the reported recurrence rates in the preserved breasts. An overview of the studies that utilized sentinel lymph node biopsy after neoadjuvant chemotherapy is presented, summarizing the identification rates and false-negative rate.     

Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006.

Neoadjuvant (primary systemic) treatment has become a standard option for primary operable disease for patients who are candidates for adjuvant systemic chemotherapy, irrespective of the size of the tumor. Because of new treatments and new understandings of breast cancer, however, recommendations published in 2006 regarding neoadjuvant treatment for operable disease required updating. Therefore, a third international panel of representatives of a number of breast cancer clinical research groups was convened in September 2006 to update these recommendations. As part of this effort, data published to date were critically reviewed and indications for neoadjuvant treatment were newly defined.     

Primary (neoadjuvant) chemotherapy with docetaxel in breast cancer

The use of primary or neoadjuvant chemotherapy for locally advanced breast cancer, including those patients with inflammatory breast cancer, is well established. The use of primary chemotherapy has also been investigated in patients with operable breast cancer. The potential benefit of using primary chemotherapy is the opportunity to administer systemic therapy at an earlier timepoint, where it may be more effective against microscopic disease. In addition, primary chemotherapy for patients with operable breast cancer may also result in higher rates of breast conservation, axillary nodal downstaging, and potential improvement in patient outcome. A variety of different chemotherapy drugs have been evaluated in the primary chemotherapy setting. One of the most common approaches is to use an anthracycline-based regimen for 4 or more cycles of treatment before considering definitive local therapy. Although high tumor response rates have been reported using anthracycline-based regimens, the fraction of patients actually attaining a pathologic complete response has remained small (less than 20%). With the introduction of new chemotherapy drugs, such as docetaxel, which is associated with a very high tumor response rate in metastatic disease, a natural evolution of clinical investigation is to use docetaxel in the neoadjuvant or primary chemotherapy setting. Some of the recent trials that have evaluated single-agent docetaxel, docetaxel-based chemotherapy combinations, and novel sequencing strategies that include docetaxel in the neoadjuvant setting are reviewed. The results from these trials clearly suggest that docetaxel-containing treatment strategies can be considered a standard in the primary chemotherapy setting     

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。