局部晚期乳腺癌的保留乳房手术

乳腺癌是女性最常见的恶性肿瘤之一,局部晚期乳腺癌(LABC)的治疗是世界范围内的临床难题,影响着乳腺癌总体生存率的提高。LABC的涵盖范围伴随着TNM分期系统的修订而不断变化。已有的研究证明,新辅助化疗后可以进行保留乳房手术(BCT),但要严格掌握适应证,保留乳房手术的指征已逐渐取得共识。开始治疗之前准确记录或定位肿瘤,要保证足够的阴性切缘。对于腋窝淋巴结手术问题仍有争议,多数主张常规进行清除手术。预后上不差于早期乳腺癌作保留乳房手术后的局部复发率。     

High-intensity focused ultrasound castration for breast cancer patients

Breast cancer is a kind of hormone dependent malignant tumor, so the role of endocrine treatment is very important in colligation therapeutics of this disease. Conventional bilateral oophorectomy or RT is frequently used for patients with high risk of recurrence. The potential therapeutic use of external HIFU was first explored by Lynn et al in 1942[1]. They demonstrated HIFU can induce localized tissue damage at a focal point within the body with no effect on the surface or on the overlyi…     

High-dose medroxyprogesterone acetate versus oophorectomy as first-line therapy of advanced breast cancer in premenopausal patients.

Forty premenopausal patients with advanced breast cancer entered a prospective and randomized study in which high-dose medroxyprogesterone acetate (HD MAP) and oophorectomy (OPX) were compared. All the patients were first treated for advanced disease. Twenty-two patients received HD MAP (1,000 mg b.i.d. p.o.) and 18 patients received OPX. Complete remission (CR) was achieved in 2 (9%) in the HD MAP group and in 2 (11%) in the OPX group for a duration of 20-24 and 30-54 months respectively. Partial remission (PR) was achieved in 10 (45%) patients in the HD MAP group and in 4 (22%) patients in the OPX group for a median duration of 9 and 7 months respectively. The objective response rates (CR + PR) were 55% for the HD MAP group and 33% for the OPX group (p = 0.17). Ten patients who received OPX as first-line treatment received HD MAP when the disease progressed and were evaluable for response: PR was achieved in 6 patients (2 responders and 4 nonresponders to OPX) for a median duration of 5 months. Two out of 4 patients who received OPX at progression after objective response to HD MAP presented PR. HD MAP induced a significant decrease in pain intensity and, compared to OPX, a more frequent improvement was induced in performance status. No difference was observed between the two groups in terms of overall survival. This study shows that HD MAP is an active treatment in premenopausal patients with advanced breast cancer and that it can induce a response in some patients resistant to OPX.     

Chemoendocrine therapy in advanced breast cancer

Summary The effect of a combination of endocrine and chemical therapies has been studied during the past decade in DMBA-induced rat mammary tumors and advanced human breast cancers. Although interferential effects have been observed between endocrine therapy and chemotherapy in highly hormone-dependent tumors or cell lines, beneficial effects can be achieved from a combination of these two treatment modalities in human breast cancer when the steroid receptor status and the presence or absence of visceral metastases are considered in the selection of treatment programs. Address for reprints: David T. Kiang, M.D., Box 168, University of Minnesota Hospitals, Minneapolis, MN 55455.Associate Professor of MedicineProfessor of Medicine and Masonic Professor of Oncology     

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%.     

Conventional dose CAF therapy versus low dose adriamycin therapy in the treatment of advanced breast cancer

A controlled randomized trial was conducted to compare the effectiveness of a conventional dose of CAF therapy with that of a low dose of adriamycin (ADR) therapy for the treatment of advanced breast cancer. The doses of medication for the conventional CAF therapy were 100 mg/body of cyclophosphamide (CPA) p.o. daily for two weeks, 30 mg/m² of ADR and 500 mg/m² of 5-fluorouracil (5-FU) i.v. on days 1 and 8 for induction, and 200 mg/body of 5-FU and 20 mg/body of tamoxifen (TAM) p.o. daily for maintenance. Those for the low dose ADR therapy were 15 mg/ m² of ADR i.v. at two-week intervals for one year and 200 mg/body of 5-FU and 20mg/body of TAM p.o. daily. Eighty patients were entered in this trial. All patients were randomly divided into two groups with stratification for estrogen receptor status. Of 78 patients among them, 38 undergoing the CAF therapy and 40 undergoing the low dose ADR therapy, were evaluated for efficacy assessment. The background factors analyzed were well balanced in both groups. The response rate was 47% (6 CR, 12 PR out of 38) in the CAF group and 43% (3 CR, 14 PR out of 40) in the low dose ADR group. There was no significant difference in response rates and survival rates as determined by the Kaplan Meier method between the two groups. The CAF therapy had significantly more toxicity than the low dose ADR therapy. Therefore, it was concluded that this low dose ADR therapy can be regarded as a treatment of choice for advanced breast cancer.     

Principles of therapy in advanced breast cancer

Advanced breast cancer represents a common clinical problem faced by medical oncologists, internists, surgeons, and radiation oncologists. The medical oncologist or internist is usually the patient's primary physician and is responsible for coordinating the multiple disciplines to optimize the therapeutic management. In the case of locally advanced (stage III) breast cancer, there are far fewer prospective clinical trials on which to base management decisions than are available in the metastatic disease setting. The primary cancer care physician's responsibility is particularly great for coordination of the multidisciplinary approach and integration of medical oncology, radiation oncology, and surgical treatment modalities, however. In the case of metastatic breast cancer, an understanding of the importance of certain clinical factors (that is, hormonal receptors, performance score, disease-free interval, sites and extent of metastasis, and tempo of disease) is crucial to the development of the therapeutic plan in the individual patient. Although entry on a state-of-the-art clinical trial is the appropriate goal, this is not always possible, and an understanding of therapeutic options is essential. Palliation is the key word in the management of metastatic breast cancer, and hormonal therapy is generally the most appropriate course unless the patient is not a hormonal candidate because of sites, extent, or tempo of disease, or because of the known lack of hormonal receptors. Of particular importance is attention to sites of bone metastasis where appropriate radiation therapy and/or surgical intervention can relieve pain or prevent a devastating fracture with resultant loss of mobility and decrease in quality of life.     

Alternating sequential endocrine therapy: tamoxifen and medroxyprogesterone acetate versus tamoxifen in postmenopausal advanced breast cancer patients.

The effects of tamoxifen (TAM) versus the alternating sequential combination of TAM plus medroxy-progesterone acetate (MPA) has been evaluated in 20 postmenopausal patients with advanced breast cancer in a randomized controlled trial. In the TAM arm, patients received 20 mg b.i.d. of TAM. In the TAM-MPA arm, patients received only 20 mg b.i.d. of TAM for 7 days and, on the following 7 days. TAM plus an oral daily dose of 500 mg of MPA, in alternating sequence. Objective tumor reduction was achieved in 22 (41%) of the 54 patients in the TAM arm and in 25 (43%) of the 58 patients in the TAM-MPA arm. With regard to the stabilization of disease, a significant difference was observed between patients treated with the TAM-MPA combination and those treated with TAM alone (47% vs 22%). The percentage of nonresponders was also significantly higher in the TAM group (37%) than in the TAM-MPA group (10%). The time to progression was significantly shorter for the TAM arm than for the TAM-MPA arm (median, 7 vs 15 months), but the duration of remission was not significantly different for either treatment.     

Hormonal therapy for advanced breast cancer

Hormonal therapy for advanced breast cancer has evolved significantly in the more than 100 years since the first publications documenting the effect of ovarian ablation on advanced breast cancer in premenopausal women. Since that time, not only have we developed the methods to measure estrogen and progesterone receptors in cancer cells, but more recently we have understood that expression of these receptors determines response to hormone therapy. The availability of more selective antiestrogen therapies has changed and significantly improved the treatment options for women who have advanced hormone-responsive breast cancer. Current research is focusing on reversing resistance to hormone therapy with the addition of targeted biologic agents to standard hormonal treatment.     

Chemo-endocrine therapy of advanced breast cancer

There have been few randomized trials that have shown a significantly longer survival after chemo-endocrine therapy than the chemotherapy or the endocrine therapy alone, although there seem to be rationales for simultaneous combination of the both modalities. Some new strategies that would make the response rate higher as well as obtain a longer survival by means of chemo-endocrine therapy was suggested. At the present time, sequential endocrine therapy to chemotherapy is recommended for the advanced or recurrent breast cancer patients, except for those with larger tumor burden, liver metastasis, rapid growing tumors, and ER-negative tumors.     

Quality of life in patients undergoing systemic therapy for advanced breast cancer

To date no published reviews have examined the effects of systemic therapy on health-related quality of life (HRQOL) in patients with advanced breast cancer. We did a systematic review identifying 19 randomised controlled trials, with 5732 participants. Most of the trials (12) involved chemotherapy, but six involved hormonal therapies, and one a biological therapy. 15 studies assessed HRQOL as a secondary endpoint; only seven reported any significant differences in HRQOL between treatment groups. We identified several limitations with methods. Most studies reported problems with withdrawal of patients, which reduces statistical power and can lead to bias. Baseline characteristics of patients were not reported in many cases, and only three studies examined clinical significance. We conclude that HRQOL data provide some invaluable insights into the treatment and care of patients, but future studies should address several common problems with methods. We propose some approaches to overcome these limitations and improve future study designs.     

High-dose versus low-dose CMFP regimen in advanced breast cancer

Fifty cases of advanced breast cancer (stages III and IV) were treated by combination chemotherapy. The study compares the two different dose schedules and toxicities of a combination of cyclophosphamide, methotrexate, 5-flurouracil, and prednisone. Results are better with high-dose regimen, though the incidence of toxicity is much as compared to low-dose schedules, but, considering the beneficial response, the high-dose schedule is recommended.     

Mitoxantrone--a useful palliative therapy in advanced breast cancer

We have treated 76 patients with advanced breast cancer with single-agent mitoxantrone: all had previously received hormone therapy and 30 patients had also received prior chemotherapy. The overall response rate at 6 months was 15%, with a further 22% having static disease. Responding and static patients had similar survival curves and were grouped together as patients with "stable disease." Patients with stable disease had a significantly longer survival than patients with progressive disease (p less than 0.001); the median difference in survival was 9 months.     

晚期乳腺癌及复发性乳腺癌的介入治疗

目的研究晚期乳腺癌及术后复发性乳腺癌的介入治疗方法及其临床意义。方法对24例患者先行患侧锁骨下动脉造影,确定病灶的供血动脉,然后超选择插管,根据病灶的大小及血供情况注入抗癌药物。结果乳腺癌原发灶、转移淋巴结及复发病灶,均有多支动脉供血,其中胸外侧动脉、胸背动脉及内乳动脉是最常见的供血动脉。介入治疗完全缓解率(CR)为16.7%(4/24),部分缓解率(PR)为62.5%(15/24),有效率为79.2%(19/24)。并使部分不可手术乳腺癌,介入治疗后可以手术治疗。毒副作用较轻。结论介入治疗可了解病灶的供血,是对晚期及术后复发性乳腺癌有效的治疗方法。     

Sequential versus combination therapy in the treatment of patients with advanced colorectal cancer

Colorectal cancer (CRC) remains one of the most frequent cancer diagnoses and a leading cause of cancer-related deaths in the United States. Significant progress, however, has been made since the advent of single-agent 5-fluorouracil therapy. The addition of irinotecan and oxaliplatin to the cytotoxic armamentarium, mostly given in combination, has dramatically improved response rates, progression-free survival, and overall survival (OS). In recent years, the addition of biologic therapies, including bevacizumab, cetuximab, and panitumumab, has further contributed to improved outcomes. There have been recent data suggesting that sequential cytotoxic therapy, in the majority of patients, provides similar outcomes with regard to OS compared with combination chemotherapy. However, because of several limitations in the FOCUS and CAIRO trials, the data are difficult to apply to current treatment regimens. Although these data do help us further define patients who may benefit from sequential chemotherapy, the standard of care remains combination chemotherapy in the vast majority of patients. This approach will be further refined as progress is made in pharmacogenomics and in prognostic and predictive factors in treating patients with metastatic CRC.     

Megestrol acetate therapy for advanced breast cancer

One hundred twenty-four patients with metastatic breast cancer were treated with 40 mg of megestrol acetate four times daily. Complete responses (CR) or partial responses (PR) were seen in 29 patients (23%). CR, PR, or stable disease (S) was seen in 80 patients (65%). The median duration of response was 22 months for CR and PR and ten months for S. A significantly higher response rate (CR + PR) was seen in estrogen-receptor-positive (ER-positive) patients (26%) and in patients who had not received prior therapy (39%). A significant relationship to response could not be established for menopausal status, progesterone-receptor (PrR) status, dominant site of disease, or prior administration of chemotherapy. Median survival was 66+ months for responders, 35 months for patients with stable disease, and 9 months for nonresponders. These differences are all statistically significant (P less than .001). Toxicity was minimal, and side effects consisted primarily of weight gain, which was seen in 18 patients (14.5%). Megestrol acetate can provide effective palliation in patients with advanced breast cancer.