长春瑞滨联合顺铂治疗转移性乳腺癌临床观察

观察长春瑞滨 (NVB )联合顺铂 (DDP)方案治疗转移性乳腺癌的临床疗效 ,2 2例转移性乳腺癌采用NVB 2 5mg m2 ,d1 、d8;DDP 3 5mg m2 ,d1 ～d3。CR 13例 ,PR 11例 ,总有效率 (CR PR ) 75 %。主要毒副反应为骨髓抑制和静脉炎 ,采用深静脉给药可减轻静脉炎发生。NP方案治疗转移性乳腺癌疗效较高     

长春瑞滨联合顺铂治疗转移性乳腺癌临床观察

观察长春瑞滨（NVB）联合顺铂（DDP）方案治疗转移性乳腺癌的临床疗效。22例转移性乳腺癌采用NVB25mg/m^2,d1,d8;DDP35mg/m^2,d1-d3。CR13例。PR11例，总有效率（CR PR）75%。主要毒副反应为骨髓抑制和静脉炎，采用深静脉给药可减轻静脉炎发生。NP方案治疗转移性乳腺癌疗效较高。     

长春瑞滨联合顺铂治疗多柔比星耐药的晚期转移性乳腺癌疗效观察

观察长春瑞滨(NVB)联合顺铂(DDP)治疗多柔比星(ADM)耐药的晚期转移性乳腺癌的疗效及毒性。32例既往使用ADM治疗后复发转移的晚期乳腺癌患者,其中单纯癌5例,浸润性导管癌25例,大汗腺样癌1例,硬癌1例。采用NVB25mg/m2,静脉滴入,d1、d8;DDP25mg/m2,静脉滴入,d1～d3。21d为1个周期,每2～3个周期评定疗效。完全缓解(CR)1例,部分缓解(PR)17例,稳定(SD)7例,进展(PD)7例,总有效率为56.3%(18/32)。主要毒性为骨髓抑制,Ⅲ～Ⅳ度白细胞下降发生率为53.1%(17/32)。其他为恶心、呕吐、贫血、静脉炎等。初步研究结果提示,NVB联合DDP治疗ADM耐药的晚期转移性乳腺癌疗效确切,毒性反应可耐受,值得临床应用。     

长春瑞滨单药周疗方案治疗既往应用过蒽环类和紫杉类药物的晚期乳腺癌临床观察

目的 观察长春瑞滨(NVB)单药治疗对既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌的疗效和安全性.方法 我院从2008年1月至2011年7月共有31例既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌患接受了NVB单药周疗方案治疗.结果 全组化疗共113个周期,中位化疗周期数为4个(2～6个周期).完全缓解(CR)1例(3%),部分缓解(PR)7例(22%),稳定(SD)4例(13%),进展(PD)19例(61%),总有效率(RR＝CR+PR)为26%,临床获益率(CR+PR+SD＞6个月)为32%,中位疾病进展时间(TTP)4.0个月,中位生存期为13个月.主要不良反应为骨髓抑制及胃肠道反应,无化疗相关死亡病例.结论 长春瑞滨单药治疗既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌有一定疗效,且耐受性好.     

长春瑞滨联合顺铂治疗转移性乳腺癌40例疗效观察

为了观察长春瑞滨(盖诺,NVB)联合顺铂(DDP)治疗转移性乳腺癌的疗效及不良反应,应用NVB(25mg/m2,d1、d8)加DDP(25mg/m2,d1～d3)治疗转移性乳腺癌40例。40例患者中CR7例,PR12例,NC16例,PD5例,总有效率(CR+PR)为47.5%(19/40),全组中位缓解期4.5个月,主要不良反应为恶心、呕吐、白细胞减少及静脉炎,Ⅲ～Ⅳ度恶心、呕吐发生率为12.5%(5/40),Ⅲ～Ⅳ度白细胞减少率为27.5%(11/40),静脉炎为30.0%(12/40)。初步研究结果提示,NP方案联合化疗对转移性乳腺癌有较好的疗效,且毒性可以耐受。     

长春瑞滨联合顺铂治疗多柔比星耐药的晚期转移性乳腺癌疗效观察

观察长春瑞滨（NVB）联合顺铂（DDP）治疗多柔比星（ADM）耐药的晚期转移性乳腺癌的疗效及毒性.32例既往使用ADM治疗后复发转移的晚期乳腺癌患者,其中单纯癌5例,浸润性导管癌25例,大汗腺样癌1例,硬癌1例.采用NVB 25 mg/m^2,静脉滴入,d1、d8;DDP 25 mg/m^2,静脉滴入,d1～d3.21 d为1个周期,每2～3个周期评定疗效.完全缓解（CR）1例,部分缓解（PR）17例,稳定（SD）7例,进展（PD）7例,总有效率为56.3%（18/32）.主要毒性为骨髓抑制,Ⅲ～Ⅳ度白细胞下降发生率为53.1%（17/32）.其他为恶心、呕吐、贫血、静脉炎等.初步研究结果提示,NvB联合DDP治疗ADM耐药的晚期转移性乳腺癌疗效确切,毒性反应可耐受,值得临床应用.     

长春瑞滨联合表阿霉素治疗转移性乳腺癌的临床观察

目的观察长春瑞滨（NVB）和表阿霉素（EPI）联合化疗方案在转移性乳腺癌治疗中的疗效和毒副反应。方法采用NVB25mg／m^2,第1、8天,EPI60mg／m^2第1天,每21天为一周期,共用2-4周期,随访6—36个月。结果18例24处转移灶中,完全缓解（CR）37．50％（9／24）,部分缓解（PR）16．67％（4／24）,疾病稳定（SD）37．50％（9／24）,SD≥6个月者20．83％（5／24）,疾病进展（PD）8．33％（2／24）。总有效率（CR＋PR）54．17％,临床获益率（CR＋PR＋SD≥6个月）为75．00％,中他疾病进展时间TTP为6．5个月。对锁骨上淋巴结转移的有效率最高达87．50％。不良反应主要为白细胞减少、脱发和周围静脉炎。Ⅲ-Ⅳ度白细胞减少发生率为72．22％,Ⅲ～Ⅳ度静脉炎的发生率为11．11％。结论,长春瑞滨联合表阿霉素在转移性乳腺癌治疗中疗效显著,不良反应可耐受。     

长春瑞滨联合顺铂治疗转移性乳腺癌40例疗效观察

为了观察长春瑞滨（盖诺,NVB）联合顺铂（DDP）治疗转移性乳腺癌的疗效及不良反应,应用NVB（25 mg/m^2,d1、d8）加DDP（25 mg/m^2, d1～d3）治疗转移性乳腺癌40例.40例患者中CR 7例,PR 12例, NC 16例,PD 5例,总有效率（CR＋PR）为47.5%（19/40）,全组中位缓解期4.5个月,主要不良反应为恶心、呕吐、白细胞减少及静脉炎,Ⅲ～Ⅳ度恶心、呕吐发生率为12.5%（5/40）, Ⅲ～Ⅳ度白细胞减少率为27.5%（11/40）, 静脉炎为30.0%（12/40）.初步研究结果提示,NP方案联合化疗对转移性乳腺癌有较好的疗效,且毒性可以耐受.     

58含长春瑞滨方案治疗(蒽环类/紫杉类治疗后)复发转移乳腺癌的临床观察

目的:观察含长春瑞滨方案对蒽环类/紫杉类药物治疗后复发转移性乳腺癌的有效性和安全性.方法:蒽环类,紫杉类药物治疗后复发转移性乳腺癌患者61例,其中58例可评价疗效;长春瑞滨联合顺铂(NP)41例,长春瑞滨25mg/m2,第1天和第8天.静脉滴注;顺铂75～80mg/m2,静脉滴注,分割为2～5天,3周为一周期;长春瑞滨联合卡培他滨或替加氟(NF)17例,长春瑞滨用法同NP组,卡培他滨800～1 000mg/m2,分早晚两次服用,第1～14天,或替加氟600mg/m2,第2～6天,3周为一周期.化疗过程中注意观察不良反应,根据不良反应的程度调整药物用量.每两周期评价疗效.结果:长春瑞滨联合顺铂(NP)组,CR 2例(4.9%),PR 23例(56.1%),SD 14例(34.1%),PD2例(4.9%),有效率为61.0%;长春瑞滨联合卡培他滨或替加氟(NF)组,CR 1例(5.9%),PR 8例(47.1%),SD 7例(41.2%).PD 1例(5.9%),有效率52.9%.常见的不良反应主要为骨髓抑制、胃肠道反应、手足综合症、神经毒性等.结论:含长春瑞滨方案治疗蒽环类,紫杉类药物治疗后复发转移乳腺癌疗效确切,毒性可耐受,是治疗复发转移性乳腺癌的较好方案.     

国产长春瑞滨联合顺铂治疗晚期乳腺癌39例疗效分析

目的:评价国产长春瑞滨(盖诺,NVB)联合顺铂治疗晚期乳腺癌的疗效和毒副反应.方法:39例晚期乳腺癌患者采用长春瑞滨联合顺铂化疗,NVB 25mg/m2静脉滴注第1、8天,顺铂30mg/m2静脉滴注第1～3天,21天～28天为1周期,3周期以上评价疗效.结果:CR 4例,PR 16例,NC 13例,PD 6例,有效率(CR+PR)为51.3%(20/39),主要毒副反应为骨髓抑制及消化道反应.结论:长春瑞滨联合顺铂治疗晚期乳腺癌疗效确切,可望成为晚期乳腺癌的二线解救方案.     

长春瑞滨加顺铂方案治疗转移性乳腺癌

目的 研究长春瑞滨（NVB）和顺铂（PDD）联合化疗方案在转移性乳腺癌治疗中的疗效和毒副反应。方法 采用NVB 25mg／m^2,快速静滴,第1、8天,PDD 25mg／m^2,静滴,第1、2、3天,每3～4周为一周期,共用2～4周期,随访6～35个月。结果 26例中完全缓解（CR）7．69％（2／26）,部分缓解（PR）38．46％（10／26）,疾病稳定（SD）30．77％（8／26）,疾病进展（PD）23．08％（6／26）。总有效率（ORR为CR＋PR）46．15％,肿瘤控制率（CR＋PR＋SD）为76．92％,中位疾病进展时间TTP为6．5个月。其中对软组织、淋巴结转移疗效较好,对内脏、骨骼转移疗效较差。毒副反应主要为白细胞减少、胃肠道反应和周围静脉炎。Ⅲ～Ⅳ度白细胞减少发牛率为46．7％,Ⅲ～Ⅳ度静脉炎的发生率为7．69％。结论 长春瑞滨加顺铂方案在转移性乳腺癌治疗中疗效较好,毒副反应可耐受。     

多西紫杉醇联合长春瑞滨治疗蒽环类耐药性转移性乳腺癌的疗效分析

目的：观察多西紫杉醇、长春瑞滨联合方案在对蒽环类耐药转移性乳腺癌治疗中的疗效及不良反应。方法：蒽环类耐药性转移性乳腺癌35例，予多西紫杉醇联合长春瑞滨化疗，21天为1周期，至少用2周期。用世界卫生组织的疗效和抗肿瘤药急性及亚急性毒性反应分度标准评价疗效及毒性。结果：在35例可评价疗效的患者中，完全缓解10例，部分缓解13例，有效率为65．7％，临床获益率91．4％。不良反应主要骨髓抑制、脱发、消化道反应，但均可耐受，无化疗相关死亡。结论：该方案治疗蒽环类耐药性转移性乳腺癌患者，疗效较好，不良反应可耐受。     

Predictors of sensitivity of clinical breast examination (CBE)

Clinical breast examination (CBE) is one of the most common breast cancer screening modalities, but factors that affect its sensitivity are not well understood. We examined the association between CBE sensitivity and tumor, breast and personal characteristics among members of a managed care organization's Breast Cancer Screening Program (BCSP). The study population was 468 screened women 40 years and older diagnosed with invasive breast cancer between 1988 and 1994 within 1 year of a screening CBE. Logistic regression was used to evaluate the likelihood of a true positive versus a false negative CBE result, after adjustment for age, body weight and tumor size. CBE sensitivity increased with larger tumor size (17% for tumors 0.5 cm and 58% for tumors 2.1 cm, adjusted p for trend <0.001) and decreased with higher body weight (48 and 23% for the lowest and highest quartiles, adjusted p for trend <0.001). CBE was more sensitive in Asian women compared to white women (88% v.s. 35%, adjusted p = 0.04) and in current users of estrogen and progesterone combination therapy compared to never/former users (52% v.s. 33%, adjusted p = 0.08). There was an inverted U-shaped association between age and CBE sensitivity (40–49: 26%, 50–59: 48%, 60–69: 36%, 70–79: 33%, 80+: 18%, significant for oldest and youngest groups v.s. age 50–59 years). These findings suggest certain groups of women, for example, obese women and younger women, receive less benefit from CBE.     

Breast cancer following augmentation mammoplasty (United States)

Objective:Although clinical reports have raised concern that breast implants may either increase the risk of breast cancer or delay its diagnosis, epidemiologic studies have generally shown implant recipients to be at a reduced risk of subsequent breast cancer. A large retrospective cohort study was undertaken to clarify effects of cosmetic breast implantation. Methods:Medical records of 13,488 women receiving cosmetic implants at 18 plastic surgery practices and a group of 3936 patients who received other types of plastic surgery at the same practices were reviewed and information abstracted. Questionnaires were sent to all subjects located as alive, with 71% being completed. Attempts were made to obtain medical verification for all reported cancers and to obtain death certificates for deceased subjects. Results:A total of 136 breast cancers were observed among the breast implant patients. External analyses, using general population rates from the Surveillance, Epidemiology and End Results (SEER) program, resulted in 152.2 cases expected and a standardized incidence ratio (SIR) of 0.9 (95% CI 0.8–1.1). A comparable SIR was found for the other plastic surgery patients (SIR = 1.0, 95% CI 0.7–1.2). Internal analyses, directly comparing the implant patients with the other plastic surgery patients, showed a RR of 0.8 (95% CI 0.6–1.1). In neither the external nor internal analyses was there any systematic variation in risk by age or calendar year of initial implant. Risk also did not vary by years of follow-up or by type of implant. Risk was not affected by exclusion of patients who received their implants following surgery for benign breast disease. Although breast tumors tended to be detected at a somewhat later stage among the breast implant than the comparison patients, the difference was not statistically significant, nor was there any significant difference in breast cancer mortality between the two groups. Conclusions:Breast implants do not appear to alter the risk of subsequent breast cancer.     

数字化X线定位系统下Mammotome微创活检在乳腺癌早期诊断中的应用

目的:探讨数字化俯卧式X线定位系统下Mammotome微创切除不可触及乳腺病灶在乳腺癌早期诊断的临床应用价值。方法:2004年12月~2005年5月,应用LORAD数字化俯卧式穿刺床X线立体定位系统引导下Mammotome系统对67例患者73个临床不可触及乳腺钼靶X线片表现为可疑病灶进行微创切除活检。73个病灶中X线摄片:42例为孤立簇状聚集钙化,27例为不规则致密影并簇状钙化,4例为局部腺体结构扭曲。术前BIRADS评级Ⅲ、Ⅳ和Ⅴ级分别为51、17和5个。结果:67例患者73个病灶,乳腺癌13个(17.8%),其中4个为乳腺导管内癌,3个导管内癌并早期浸润,6个浸润性导管癌。良性病变60个(82.1%)。13个乳腺癌术后分期:2个为0期,9个为Ⅰ期,2个为ⅡA期,13个中11个为早期乳腺癌(84.6%)。结论:应用LORAD数字化俯卧式X线立体定位系统引导下Mammotome系统微创活检不可触及乳腺X线摄片发现的微小病灶,是一种确诊早期乳腺癌的微创方法。     

诺维本联合阿霉素一线治疗72例转移性乳腺癌

目的 分析72例接受诺维本加表阿霉素联合化疗方案一线治疗转移性乳腺癌患者的疗效及毒性。方法 72例未经化疗的转移性乳腺癌患者，接受诺维本25mg／m^2每周，静滴d1、d8，表阿霉素静注d1，每3周重复。结果 72例可评价疗效、毒性、生存期，完全缓解12．5％(9／72)，部分缓解65．3％(47／72)，稳定18．1％(13／72)，进展4．2％(3／72)，CR PR77．8％(56／72)。WHO血液血毒性：在360个化疗疗程中，Ⅲ和Ⅳ度粒细胞减少分别是32％和16％，Ⅲ和Ⅳ度非血液血毒性低。中位病变进展时间(TTP)为13个月(1～23月)，中位生存期为25个月(3～34月)。结论 诺维本联合表阿霉素一线治疗转移性乳腺癌疗效高、毒性低。     

保留皮肤的乳腺癌改良根治术后即时乳房再造15例

目的探讨一种既达到肿瘤根治性切除,又保留乳房美观外形的乳房再造的手术方法。方法对早期乳腺癌,保留乳房皮肤,切除乳腺组织和腋窝淋巴结。应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造。结果应用下腹部横行腹直肌肌皮瓣乳房再造10例,扩大背阔肌肌皮瓣再造5例。优11例（73．3％）,良4例（26．7％）。结论保留皮肤乳腺癌根治术后即时乳房再造,切口隐蔽,再造乳房形态效果好。对早期乳腺癌患者是一种安全可行的治疗方法。     

Multibeam inverse intensity-modulated radiotherapy (IMRT) for whole breast irradiation: a single center experience in China

Purpose

To present the clinical experience in our cancer center with multibeam inverse intensity-modulated radiotherapy (IMRT) for early stage breast cancer (BC) patients with whole breast irradiation (WBI).

Methods

We retrospectively analyzed 622 patients with Stage 0 to III BC treated from 2008 to 2011 with wide local excision and WBI, using an inverse IMRT technique. All of the patients were prescribed a total dose of 50 Gy to the whole breast in 2-Gy fractions, followed by a tumor bed boost of 10 Gy in 5 fractions using an electron beam.

Results

Of all of the patients, 132 (21.2%) received whole breast plus regional lymph node (RLN) irradiation. 438 of 622 patients had records of acute skin toxicity based on common terminology criteria (CTC) for adverse events. Two hundred eighty (64%) patients had Grade 0/1 toxicity, 153 (35%) had Grade 2 and only 4 patients experienced grade 3 toxicity. Seventy patients (16%) had moist desquamation. Univariate analysis revealed that breast planning target volume was the only predictive factor for Grade ≥2 acute dermatitis (P = 0.002). After 4 years, 170 patients reported cosmetic results by self-assessment, of whom 151 (89%) patients reported good/excellent cosmetic results, and 17 (11%) patients reported fair assessments. For invasive cancer, the four-year rate of freedom from locoregional recurrence survival was 98.3%. Regarding carcinoma in situ, no patients experienced recurrence.

Conclusion

BC patients who underwent conservative surgery followed by inverse IMRT plan exhibited acceptable acute toxicities and clinical outcomes. Longer follow-up is needed.