乳腺癌患者保乳治疗的临床观察

目的:观察早期乳腺癌保留乳房手术加术后放疗的疗效、副反应及美容效果。方法:2001年7月~2003年9月共收治早期乳腺癌39例,其中Ⅰ期27例,Ⅱ期12例。行单纯肿瘤切除加腋淋巴结清扫。术后全乳切线照射50Gy,瘤床追加电子束照射1125cGy。患侧锁骨上X线30Gy 电子束2250cGy。结果:随访12~38个月,均无复发。放疗急性副反应包括乳房不适9例(23·08%),皮肤红斑、色素沉着17例(45·59%),湿性脱皮5例(12·82%),放射性食管炎4例(12·5%),放射性肺炎1例。无皮肤的纤维化、坏死、毛细血管扩张、乳房及上肢水肿等并发症发生。美容效果达到满意及一般者共占所有患者的94·87%。结论:保留乳房手术加术后放疗生存率及美容效果满意,并发症发生率低,对符合条件的Ⅰ、Ⅱ期患者可用此术。     

Adjuvant aminoglutethimide therapy for postmenopausal patients with primary breast cancer

Three hundred and twenty-two postmenopausal patients with primary breast cancer and ipsilateral axillary node involvement were randomized to receive aminoglutethimide and hydrocortisone or placebo for 2 years in a double blind randomized trial between April 1980 and March 1985. Two hundred and eighty-six patients were eligible for the study of whom 145 received active drug and 141 received placebo. At the present time significantly fewer patients have relapsed or died without previous relapse in the treatment arm (P = 0.002); 43 of 145 (30%) patients receiving aminoglutethimide have relapsed or died compared with 63 of 141 (40%) of those receiving placebo. Local recurrence is also significantly reduced (P = 0.002) since only 6 patients receiving active treatment developed local recurrence compared to 21 receiving placebo. Side effects were severe enough to necessitate complete withdrawal or reduction of therapy in 27 of 145 (19%) in the treatment arm of the study compared with 21 of 141 (15%) in the placebo arm. A single treatment-related death occurred, due to agranulocytosis. Aminoglutethimide and hydrocortisone therefore delay relapse after surgery for primary breast cancer in postmenopausal women. It is too early to assess any effect on overall survival.     

Adjuvant therapy for breast cancer patients with negative lymph nodes

Although approximately 50,000 cases of axillary node-negative breast cancer are diagnosed in the United States annually, the natural history of this heterogeneous disease is incompletely defined. Several series have reported 5-year relapse-free and overall survival ranging from 56% to 89% and 74% to 92%, respectively. Tumor necrosis and anaplastic morphology correlate with early treatment failure. The estrogen receptor and size of the primary tumor are probably also predictive of clinical course. Thus far, perioperative cyclophosphamide is the only systemic treatment demonstrated to prolong survival in a statistically significant fashion. Several ongoing studies are investigating the role of tamoxifen or cytotoxic chemotherapy, or both, in prospective randomized trials. However, too few patients with insufficient follow-up have been analyzed to permit definitive conclusions or recommendations.     

Adjuvant therapy in elderly patients with breast cancer

The elderly population has been neglected by the traditional approach to clinical breast cancer research. Elderly women have been underrepresented in breast cancer clinical trials, with the majority of studies being restricted to patients aged < 70 years. Elderly patients frequently have comorbidities and/or impaired organ function. These facts may often lead to death from causes other than cancer, thus nullifying any possible benefit of adjuvant treatment; furthermore, they render extrapolation of standard treatment recommendations to the elderly potentially hazardous, particularly with respect to chemotherapy. Therefore, specific clinical trials are needed to investigate adjuvant treatments tailored for the heterogeneous older population.     

光动力疗法治疗乳腺癌27例

 目的 探讨光动力疗法在乳腺癌治疗中应用的方法和临床意义。方法 2005年6月至2005年12月，应用光动力疗法治疗术前通过淋巴结显像证实有内乳区淋巴结转移的乳腺癌12例、乳腺癌术后胸壁复发15例。结果 术前淋巴结显像测定内乳区淋巴结直径在0.5 ~ 1.0 cm者，术后3个月复查完全消失。乳腺癌术后胸壁复发的病例，直径在1.0 cm以下的小病灶完全缓解。结论 光动力疗法对协助清除内乳区转移的淋巴结和治疗乳腺癌术后胸壁复发有确切疗效。     

Targeted therapy for breast cancer in older patients

Older patients are one of the most relevant sub-groups of patients with breast cancer and will only gain in importance as demographic transition unfolds. Their management, in both the early and advanced settings, should take into consideration specific clinical needs and is made more difficult by the limited availability of evidence on the efficacy and safety of standard treatment regimens in older patients. At the root of this situation is the low rate of participation of older patients in clinical trials, often due to age limits for inclusion, and limitations on the participation of persons with significant comorbidities or organ dysfunction. Although this has begun to change in recent years, most agents currently in use have not been tested in a substantial number of older patients. This includes the targeted agents that have, in the last fifteen years, changed the prognosis of patients with early and advanced breast cancer. Most data guiding the use of targeted agents in older patients come from sub-analysis of larger trials or small retrospective cohort studies. The goal of this review is to go over the available evidence regarding the efficacy and safety of targeted agents approved for use in breast cancer (trastuzumab, lapatinib, T-DM1, pertuzumab, neratinib, palbociclib, bevacizumab, ribociclib, abemaciclib, everolimus, olaparib, talazoparib), and place their side effects into an older-specific context in order to help medical oncologists when making treatment decisions and managing older patients with breast cancer.     

Long-term telephone therapy outcomes for breast cancer patients

We present the results of a breast cancer clinical trial that tested two therapy interventions delivered by telephone. Women (N = 218) with Stages I, II, or III breast cancer were randomly assigned to breast cancer health education or emotional expression interventions, or to a standard care control condition. Outcome and process measures were obtained at baseline, 6-month and 13-month follow-ups. Oncology certified nurses conducted the therapies in six, 30-minute individual phone sessions. Women in the health education condition reported significantly better knowledge and less perceived stress compared to women in the emotional expression and control conditions. No treatment effects, however, were obtained for quality of life or mood, and all women generally improved on these measures over time. Secondary analyses showed that younger women and women with a more advanced stage of breast cancer reported significantly greater avoidant coping. The data show that telephone therapy is a viable delivery modality and that distress improves with time for most women. Overall, this study showed that neither of the two telephone interventions tested had a meaningful effect on quality of life or mood.     

Chemo/endocrine therapy for breast cancer patients

Standard adjuvant chemo/endocrine therapy for breast cancer patient is based upon St. Gallen's consensus 1998. Recent development in the field of adjuvant chemo/endocrine therapy is an usage of LH-RH analogue with tamoxifen for premenopausal hormone receptor positive women, and also an emerging role of taxans. Orally given 5-FU derivatives may work in adjuvant settings. The third generation aromatase inhibitors have established their role in second line hormone therapy for the advanced or recurrent breast cancer patients. High dose chemotherapy should not be used in outside clinical trials.     

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.     

乳腺癌患者应用内分泌药物治疗后合并脂肪肝的临床分析

目的：分析乳腺癌患者应用内分泌药物后发生脂肪肝的机理及预防。方法：收集住院及门诊服用内分泌药物治疗的乳腺癌患者,通过血脂、腹部CT或B超检查,探讨合并脂肪肝的机理。结果：107例患者均有不同程度的脂肪肝发生,轻度脂肪肝42例,中度脂肪肝37例,重度脂肪肝28例。中断内分泌治疗13例。最早发生脂肪肝服药3月,最晚服药近2年,平均13月。结论：乳腺癌服用内分泌治疗的患者应注意预防脂肪肝的发生并给予及早的干预治疗。     

Adjuvant therapy of breast cancer patients

The paper discusses the state of the art in adjuvant treatment of breast cancer patients. The protocol of the randomized controlled study of the effectiveness of adjuvant chemohormonotherapy conducted at the Petrov Institute since January, 1985 is presented. It is suggested that all oncological institutions concerned should take part in a cooperative investigation to be carried out along the guidelines outlined in the protocol.     

Combination therapy of patients with locally advanced breast cancer

The investigation involved 30 patients with locally advanced breast cancer (T3-4N1-2M0). Combination therapy comprised two courses: carboplatin 300 mg/m2, i.v., dropwise, on day 1; doxorubicin 30 mg/m2, i.v., bolus-flow, on days 1 and 8; 5-fluorouracil 350 mg/m2, i.v., bolus-flow, on days 1 and 8, and irradiation of the breast and regional metastasis area (single target dose--2 Gy, total target dose--40 Gy). Overall clinical response was 96.7% (29/30), mammography-wise--83.3% (25/30). All patients were found operable and radical mastectomy was performed in 25. Therapeutic effect stage III-IV was histologically confirmed in 40% (25/30), stage I-II--60% (15/25). Median overall and recurrence-free survival was not reached within 36 months in 24/30, relapse-free survival was been reported in 16/24 (66.6%), tumor progression--8/24 (33.4%). Three-year; host-mastectomy recurrence-free survival--68.8 +/- 16.0%.     

Capecitabine maintenance therapy for XT chemotherapy-sensitive patients with metastatic triple-negative breast cancer

Objective： To investigate the efficacy and safety of capecitabine maintenance therapy（MT） after initial capecitabine plus docetaxel（XT） chemotherapy in patients with metastatic triple-negative breast cancer（m TNBC）.
Methods： Fifty-five m TNBC patients treated with XT chemotherapy between May 2007 and June 2013 were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, capecitabine was continued for 32 patients（MT）, while 23 patients remained without any treatment（nonMT）. We compared progression-free survival（PFS） and safety of both groups.
Results： The median PFS of 55 patients was 8.1 months, overall median PFS time of 32 patients in the capecitabine MT group and 23 in the non-MT group was 10.1 vs. 6.7 months（P=0.032）, respectively. When compared PFS time of maintenance treatment, single-agent capecitabine prolonged PFS by 7.1 months, for non-MT patients, the PFS without any treatment was 3.1 months, and this between-group difference was statistically significant（P=0.003）. Adverse events, including of hematologic toxicity, gastrointestinal toxicities, hand-foot syndrome and abnormal liver function were not significantly different between two groups.
Conclusions： After initial disease control was achieved with the XT combination chemotherapy, capecitabine MT can significantly prolong PFS time with a favorable safety profile in m TNBC patients.     

Radiation therapy for brain metastases in breast cancer patients

Most randomized comparison trials (RCTs) investigating treatments for brain metastases (BM) have included BM from any origin; as a result, more than half (52.4–77.0%) of the BM in these trials originated from the lungs (mostly non-small-cell lung cancer, NSCLC), with the breasts being the origin in only 6.8–19.0% of cases. In addition, patients with poor systemic status (KPS < 70) were not included in these trials. Hence, before we can apply RCT-based information to the daily clinical treatment of BM from breast cancers, it will be crucial to differentiate the characteristics of BM originating from NSCLC and BM originating from breast cancer. Although stereotactic radiosurgery (SRS) is widely used in Japan, level-1 evidence suggests that the benefit of using SRS in addition to whole-brain radiation therapy (WBRT) has been proven only for patients with a single BM. Treatment with SRS alone, which is widely used in Japan, seems attractive because it could avoid the risk of long-term adverse effects of WBRT. However, level-1 evidence suggests that the omission of WBRT results in a high frequency of brain tumor recurrence (BTR). In an RCT between SRS-alone and SRS + WBRT conducted in Japan, we found that patients who had a single BM and no extracranial metastases had a low risk of developing BTR after initial brain management (low-risk group) compared with those who had 2 or more BM and extracranial metastases (high-risk group). In order to meet the criteria of “low-risk” BTR, patients also should have good systemic status (KPS ≧ 70). Epidemiologic data suggest that the prognosis is twice as likely to be poor in patients with BM from breast cancer (RPA III = KPS < 70) than in patients with BM from NSCLC (40 vs. 20%); in addition, the probability of brain-only metastases in patients with breast cancer is less than half that in patients with NSCLC (20–25 vs. 60–75%). Considering these findings, we should be aware that most patients with BM from breast cancer are not good candidates for SRS alone, and, therefore, the role of WBRT is still important in the era of modern radiation techniques.     

Occupational therapy intervention with patients with breast cancer: a survey

Occupational therapists (OTs) working with patients with breast cancer provide a variety of therapeutic interventions. A survey was undertaken to record the different assessments and treatments employed by OTs in a specialist cancer centre with the type and length of interventions recorded on a log sheet by each therapist over a period of a month. A significant amount of time was spent facilitating educational programmes, teaching relaxation techniques and exploring strategies for managing breathlessness and fatigue. However, documentation and report writing consumed the largest proportion of the therapists' time. Less time was spent on assessment of activities of daily living and home assessments, often perceived to be the traditional domain of OTs.     

Preoperative chemotherapy and endocrine therapy in patients with breast cancer

This review focuses on the aims, results, advantages, and possible disadvantages of preoperative chemotherapy and endocrine therapy. We present the recent improvements in terms of pathologic response rates that have resulted from new combinations of drugs. The change of established prognostic factors during neoadjuvant treatment, the need for new markers, and the consequences in terms of clinical decision-making are demonstrated. We discuss the risk of local relapse after breast-conserving surgery, which was made feasible by preoperative chemotherapy. A short overview of current neoadjuvant cytostatic, endocrine, and immunotherapy trials is provided. Future opportunities for tailoring therapy to each individual patient based on early information from the primary tumor are discussed. Important considerations and results of recent endocrine trials that analyzed possible tamoxifen-resistance in subgroups are reported. New opportunities exist to evaluate the efficacy of new cancer drugs more rapidly in the neoadjuvant setting than in the metastatic and adjuvant setting. This approach offers the possibility of monitoring prognostic markers in the primary tumor before, during, and after treatment with specific chemotherapeutic agents. With respect to recent findings of gene-array techniques, it is likely that the advances in this technology will lead to improved prognostic statements. It will show the influence of therapy on gene expression profiles in the course of treatment and might enable us to identify chemoresistance of specific tumors rather early. This could potentially lead to a new direction of cancer therapy.     

保乳术后放疗对乳腺癌局部淋巴结转移患者预后的影响

  目的  探讨术后放疗(post-mastectomy radiation therapy, PMRT)对局部淋巴结阳性行保乳手术的乳腺癌患者预后的影响, 针对不同的pN分期以及淋巴结转移率(lymph node ratio, LNR)提出更具针对性的术后放疗方案。  方法  回顾性分析天津医科大学肿瘤医院1998年2月至2007年3月152例行保乳手术并有局部淋巴结转移的原发浸润性乳腺癌患者的临床病理资料, 比较LNR和pN分期对患者预后的指导意义, 并在LNR基础上, 根据PMRT与否比较无病生存期(disease-free survival, DFS)和总生存期(overall survival, OS)。  结果  152例患者被分为pN1(114例)、pN2(23例)、pN3(15例), 其中LNR < 0.21为114例, 位于0.21~0.65为26例, >0.65为12例。单因素分析显示淋巴结切检总数、pN、LNR、雌激素受体(estrogen receptor, ER)状态、孕激素受体(progesterone receptor, PR)状态、放疗与否均与DFS、OS具有相关性(P < 0.05), 诊断年龄和化疗方案仅与OS具有相关性(P < 0.05)。多因素分析显示, LNR、PMRT依然是DFS、OS的独立预测指标(P < 0.05), 而pN差异无统计学意义(P>0.05);分组分析时仅在LNR < 0.21术后放疗对预后的影响差异有统计学意义。  结论  LNR作为一个独立预测指标, 可用于评价行保留乳房手术治疗发生淋巴结转移的乳腺癌患者的预后。针对不同的LNR分级, 需要进一步细化PMRT的适应症。      

Bilateral primary breast cancer in patients treated with adjuvant therapy

Between 1974 and 1986, 1036 patients with operable breast cancer were treated with doxorubicin-containing combination chemotherapy regimens. Of these, 44 patients had bilateral breast cancer prior to initiation of adjuvant therapy (prechemotherapy) and 17 patients developed primary breast cancer on the contralateral side during or after completion of adjuvant therapy (postchemotherapy). The objectives of the study were twofold: to determine the incidence of bilateral primary breast cancer and to determine the effect of second primary breast cancer on prognosis of patients treated for disease in the contralateral breast. The estimated disease-free and overall survival of patients with prechemotherapy bilateral disease was similar to the patients with unilateral breast cancer. Four hundred eight patients received tamoxifen in addition to combination chemotherapy during adjuvant therapy. The incidence of contralateral breast cancer at 2 years in patients treated with tamoxifen was 0.4% in comparison to 0.8% in patients treated with chemotherapy alone. Time to development of second breast cancer in patients treated with or without tamoxifen was not significantly different (p = 0.41). We conclude that patients with bilateral breast cancer have a prognosis similar to that of patients with comparably staged unilateral disease. Although the rate of bilateral disease observed among patients treated with adjuvant chemotherapy and tamoxifen was somewhat lower than for those receiving chemotherapy only, the difference was not statistically significant.     

Recent progress in endocrine therapy of patients with breast cancer

Endocrine therapy of breast cancer was reviewed historically, and growth or regression of the tumor in relation to estrogen level in pheripheral blood was elucidated. Discovery of anti-estrogens has brought big revolution in the therapy of breast cancer. Recent developments of GnRH analogue and inhibitor of steroidgenesis are expected to give us more useful tools for the treatment of the disease. Combinations of such hormonal drugs with different action mechanisms will be resulted in better prognosis of breast cancer patients.