CEF方案序贯多西他赛辅助化疗治疗45例淋巴结阳性乳腺癌

[目的]评价CEF方案序贯多西他赛在淋巴结阳性乳腺癌术后辅助化疗中的疗效与毒副反应。[方法]90例淋巴结阳性乳腺癌患者术后分为两组,分别给予CEF方案（A组）和CEF方案序贯多西他赛（B组）进行辅助化疗。随访时间38～48个月。[结果]A组3年无病生存率（DFS）57.8%,3年总生存率（OS）为75.6%。B组3年DFS为84.4%（38/45）,3年OS为91.1%（41/45）,两组比较差异有显著性（P值均〈0.005）。在绝经后、淋巴结转移4～9枚,T3期以及ER阴性患者中B组的3年无病生存率高于A组。多因素分析治疗方法、肿块大小及受体状况等方面与3年DFS及3年OS均相关。[结论]CEF方案序贯多西他赛的化疗方案在淋巴结阳性乳腺癌术后辅助化疗中比CEF方案得到更高的3年无病生存率及总生存率,特别是对肿块相对较小、受体阴性的患者而言获益更大。     

乳腺癌术后辅助化疗的Meta分析

全文对最近4年有关乳腺癌术后辅助化疗的Meta分析作一回顾。早期也腺癌（I－Ⅱ期）术后辅助化疗，对50岁以下患者的10年生存率可提高7％－11％，50岁－6岁者可提高2％－3％；含蒽环类多药化疗其5年绝对死亡率较不含蒽环类的多药化疗提高3％。无毒性－症状生存分析表明其术后辅助化疗获益程度明显超过其化疗负担。比杉醇类药物在乳腺癌辅助化疗中的结果令人鼓舞，但尚不是结论性的。对雌激素受体阳性（ER（＋））乳腺癌患者术后加用三苯氧胺（TAM）可减少复发、提高生存率。     

乳腺癌术后辅助化疗的进展

辅助化疗是乳腺癌综合治疗中的重要组成部分,也是预防远处转移的主要手段。本文对近年来乳腺癌术后辅助化疗进展的相关文献进行了回顾,在内科治疗方面,规范化、个体化是乳腺癌辅助治疗的方向。     

TE方案与TEC方案在乳腺癌新辅助化疗中的疗效比较

[目的]对比分析多西他赛联合表柔比星加/不加环磷酰胺（TEC/TE）两种新辅助化疗方案治疗乳腺癌的近期疗效。[方法]回顾性分析2006~2009年收治的Ⅱ~Ⅲ期乳腺癌新辅助化疗患者108例的临床病理资料,分别术前接受新辅助化疗的TE方案（n=62）及TEC方案（n=46）,两组患者均在术前接受2~4个周期化疗。TE方案：多西他赛75mg/m2,第1天静脉滴注;表柔比星（EPI）60mg/m2,第1天静脉滴注。[结果]全组108例患者均可评价疗效,CR 10例（9.25%）,PR 75例（69.44%）。TE组有效率为75.81%,而TEC组有效率为82.61%,两组有效率无统计学差异（χ2=0.729,P=0.392）。Ⅱ期患者28例均生存。Ⅲ期患者80例3年生存率为82.4%,其中TE组44例3年生存率为74.6%;而TEC组36例3年生存率为91.8%,差异有统计学意义（χ2=4.149,P=0.042）。[结论]在Ⅱ~Ⅲ期乳腺癌患者新辅助化疗中,TE与TEC方案近期疗效相似,TEC组3年生存率较佳,有待于进一步加大样本量进行研究。     

以紫杉醇周疗法改良标准密集EC→P方案用于高危乳腺癌辅助化疗的临床研究

[目的]评价改良的密集EC序贯紫杉醇每周给药方案用于高危乳腺癌患者术后密集化疗的临床疗效和安全性,[方法]62例高危复发乳腺癌患者,术后随机分成密集组3l例,常规组31例,密集组接受双周EC方案4个疗程．序贯紫杉醇每周疗法10周化疗。常规组接受3周EC方案4个疗程,序贯紫杉醇3周方案4个疗程化疗。[结果]中位随访38个月后,常规组接受率分别为87．1％和77．4％（P=0．174）,3年总生存率分别为90．3％车1187．1％．后异均无统计学意义（P=0．710）。两组治疗毒性均可耐受．其中在预防性G—CSF支持下密集组的白细胞减少发生率为67．7％,而常规组为83．9％,差异无统计学意义（P=0．064）[结论]以紫杉崞周疗法改良标准密集EC—P方案用于高危乳腺癌辅助化疗疗效较好,治疗毒司长可耐受,值得临床进一步研究。     

Luminal A型乳腺癌辅助化疗研究进展

乳腺癌分子分型对指导治疗有积极的意义,Luminal A型乳腺癌预后好、对内分泌治疗敏感、但化疗较不敏感,根据临床病理特征和应用基因技术避免Luminal A型乳腺癌过度化疗有一定参考意义。     

长春瑞滨联合表阿霉素作为乳腺癌术后辅助化疗方案的临床研究

目的 评价长春瑞滨联合表阿霉素方案(NE方案)作为乳腺癌术后辅助化疗方案的安全性.方法 给予61例乳腺癌NE方案化疗,长春瑞滨40 mg/m2,静脉滴注,d1,8;表阿霉素50 mg/m2,静脉注射,d1～2.21～28 d为1个周期,共4～6周期.给药后监测毒副反应和生存情况.结果 主要毒副反应为骨髓抑制、胃肠道反应,均为町逆性.5年生存率为87.9%.结论 NE方案作为乳腺痛术后辅助化疗方案,毒副反应可耐受、长期生存率高.     

周剂量紫杉醇联合顺铂作为乳腺癌术后辅助化疗方案的临床观察

目的 评价周剂量紫杉醇联合顺铂方案(wTP方案)作为乳腺癌术后辅助化疗方案的远期疗效和安全性.方法 20例乳腺癌术后患者均给予WTP方案化疗,21～28 d为1个周期,共4～6个周期.给药后监测毒副反应和生存情况.结果 全组20例患者的5年生存率为90%.主要毒副反应为骨髓抑制、胃肠道反应,均为可逆性.结论 WTP方案...     

Chemotherapy with Mitomycin-C and Cyclophosphamide Adjuvant to Surgery for Breast Cancer

The effect of adjuvant chemotherapy on breast cancer was studiedin two trials. In the first, mitomycin-C was administered intravenouslyto 203 patients and cyclophosphamide intravenously or orallyto 72 patients, within four weeks after radical mastectomy.The results were evaluated by compairing the recurrence-freerates of these patients with those of 556 patients who receivedsurgery alone. The effect of postsurgical adjuvant chemotherapy on the recurrence-freerate was statistically significantly better than that of surgeryalone when one or two axillary lymph nodes were involved inmetastasis, possibly because of the suppressive effect of chemotherapyon the establishment of hematogeneous metastases. With no orthree to seven metastases, the recurrence-free rate for patientsreceiving surgical treatment combined with adjuvant chemotherapywas higher than that for those with surgery alone, but the differencewas not statistically significant. In advanced cases havingeight or more axillary lymph node metastases, chemotherapy appearedsignificantly to reduce the recurrence- free rate compared withsurgery alone. This is possibly attributable to deteriorationin host immunity caused by chemotherapy being administered immediatelyafter surgery and affecting the host's defense mechanisms. In the second trial, which is still in progress, oral cyclophosphamidewas administered to 172 patients, 150 mg daily, for 34 daysfrom the seventh day after surgery. When compared with 179 patientshaving surgery alone, this chemotherapy increased the four-yearrecurrence-free rate in patients with no axillary lymph nodemetastases and the two-year recurrence-free rate in patientswith eight or more axillary lymph node metastases.     

Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens

Background

Treatment-related toxicity can vary substantially between chemotherapy regimens. In this study we evaluated the frequency of outpatient office visits among a cohort of early stage breast cancer survivors after completion of 4 different adjuvant chemotherapy regimens to better understand how differences in toxicities between regimens might affect health care use.

Adjuvant Chemotherapy for Breast Cancer in Older Women: An Analysis of Retrospective English Cancer Registration Data

AimsAdjuvant chemotherapy is recommended as a treatment for women with high recurrence risk early breast cancer. Older women are less likely to receive chemotherapy than younger women. This study investigated the impact of chemotherapy on breast cancer-specific survival in women aged 70 + years using English registry data.Materials and methodsCancer registration data were obtained from two English regions from 2002 to 2012 (n = 29 728). The impact of patient-level characteristics on the probability of receiving adjuvant chemotherapy was explored using logistic regression. Survival modelling was undertaken to show the effect of chemotherapy and age/health status on breast cancer-specific survival. Missing data were handled using multiple imputation.ResultsIn total, 11 735 surgically treated early breast cancer patients were identified. Use of adjuvant chemotherapy has increased over time. Younger age at diagnosis, increased nodal involvement, tumour size and grade, oestrogen receptor-negative or human epidermal growth factor receptor 2-positive disease were all associated with increased probability of receiving chemotherapy. Chemotherapy was associated with a significant reduction in the hazard of breast cancer-specific mortality in women with high risk cancer, after adjusting for patient-level characteristics (hazard ratio 0.74, 95% confidence interval 0.67–0.81).DiscussionChemotherapy is associated with an improved breast cancer-specific survival in older women with early breast cancer at high risk of recurrence . Lower rates of chemotherapy use in older women may, therefore, contribute to inferior cancer outcomes. Decisions on potential benefits for individual patients should be made on the basis of life expectancy, treatment tolerance and patient preference.     

三阴乳腺癌对含蒽环类方案新辅助化疗的反应及远期疗效

目的:本文分析三阴乳腺癌(缺乏ER、PR、HER-2表达)对含蒽环类方案新辅助化疗的反应、远期疗效和探讨可能的机制.方法:对2000年1月至2003年12月间用含蒽环类方案新辅助化疗的有长期随访资料(中位随访期5.4年)的326例乳腺癌患者进行分析,用免疫组化检测ER、PR、HER-2、p53、Ki67、E钙粘素的表达,采用Cox风险回归模型分析影响无复发生存率(relapse-free survival rate,RFS)和总生存率(overall survivalrate,OS)的预后因素,比较三阴乳腺癌和非三阴乳腺癌对含蒽环类方案新辅助化疗的反应,RFS和OS,分析三阴袁型与肿瘤分级、p53、Ki67、E钙粘素表达的关系.结果:三阴表型、肿瘤分期、组织学分级、对新辅助化疗的临床反应及pCR是影响乳腺癌预后的独立因素;三阴乳腺癌占全组病例的21.5%,与非三阴乳腺癌比较,三阴乳腺癌组有较高的pCR率(P=0.046)和临床反应率(P=0.037),但RFS及OS低于非三阴组(P=0.001,P=0.004);新辅助化疗后达到临床缓解的三阴乳腺癌RFS和OS并未得到改善;三阴乳腺癌与p53和Ki67的表达呈正相关(P=0.007,P=0.028),与E钙粘素的表达呈负相关(P=0.034).结论:三阴乳腺癌对含蒽环类药物方案新辅助化疗的临床反应率和pCR率均较高,但远期疗效却较差.其机制可能与三阴乳腺癌具有较高的增殖、侵袭转移能力和缺乏有效的治疗靶点有关.     

EC与CEF方案用于乳腺癌新辅助化疗临床观察

[目的]对比观察EC(表阿霉素 环磷酰胺)与CEF(环磷酰胺 表阿霉素 氟尿嘧啶)方案用于乳腺癌新辅助化疗的疗效及毒副反应.[方法]64例经病理组织学或细胞学证实的Ⅱ、Ⅲa期乳腺癌患者随机分为两组,EC组30例,表阿霉素75mg/m2静滴d1,环磷酰胺600mg/m2,d1,每2周重复;CEF组34例,环磷酰胺500mg/m2,d1,表阿霉素60mg/m2静滴d1,氟尿嘧啶500mg/m2静滴d1,8每3周重复.[结果]EC组CEF组的有效率分别为73.3%和76.5%,两组间差异无显著性(P＞0.05).两组不良反应也无显著性差异.[结论]EC方案和CEF方案用于乳腺癌新辅助化疗均有较高的疗效,EC方案能缩短术前化疗时间,避免延迟手术时机.     

Energy Balance in Early Breast Cancer Patients Receiving Adjuvant Chemotherapy

Weight gain is a common problem amongst women receiving adjuvant chemotherapy for early breast cancer. We undertook a study to determine the causes of this weight gain. Prospective measurements of body mass and composition (skinfolds, bioelectrical impedance, total body potassium), energy balance (resting energy expenditure dietary intake, and physical activity), were determined in 17 women during and in the 6 months after commencing adjuvant chemotherapy. Women gained significant amounts of weight (5.0 +/- 3.8; p < 0.01) and body fat (7.1 kg +/- 4.5; p < 0.01) over the year. Waist circumference (5.1 +/- 4.5 cm; p < 0.01) and abdominal skinfold (16.2 +/- 10 mm; p < 0.01) were also increased but there was a decline in fat free mass (FFM); 1.7 +/- 2.5 kg. Women due to receive adjuvant chemotherapy had a greater resting energy expenditure (REE) compared with healthy subjects (n = 21); 100.5 +/- 8.0% Harris Benedict compared to 94.5 +/- 8.4% Harris Benedict (p = 0.05). REE declined by 3% during adjuvant chemotherapy (p < 0.05), and remained depressed until at least 3 months posttreatment. There were no significant changes in dietary intake or physical activity over the year. Failure of women to reduce their energy intake to compensate for the decreased energy requirement may account for some of the weight gain. Treatment of adjuvant chemotherapy causes gain of body fat because of reduced energy expenditure, and the failure of women to reduce their energy intake to compensate for the decline in energy requirement during and in the 6 months posttreatment. Since weight gain impacts on survival, patients should be counselled to reduce energy intake and exercise during and after adjuvant treatment.     

结直肠癌术后早期应用FOLFOX方案辅助化疗的临床评价

[目的]探讨结直肠癌术后早期应用奥沙利铂联合5-Fu/甲酰四氢叶酸辅助化疗的安全性和有效性。[方法]89例根治术后的Ⅱ、Ⅲ期结直肠癌患者随机分为2组,早期化疗组与对照组分别于术后第1天和术后1个月开始辅助化疗,应用奥沙利铂联合5-Fu/甲酰四氢叶酸(FOLFOX方案),观察两组术后并发症、术后肠道功能恢复时间、切口愈合状况和化疗毒副反应发生情况及住院时间。[结果]两组手术及辅助化疗期间无死亡病例,无术后出血,无吻合口瘘。早期化疗组腹壁切口平均拆线时间10.56±2.72天,对照组10.31±2.87天,两组间无明显差异(P>0.05)。切口愈合状况无明显差异,术后胃肠道功能恢复时间,早期化疗组:61±10.5小时,对照组:65±11.2小时,两组之间无明显差异(P>0.05)。早期化疗组术后第1个周期,约1/2出现周围神经毒性症状;有15.2%出现恶心(Ⅰ度)、偶有呕吐(Ⅱ度),无Ⅱ度以上腹泻发生,白细胞、血小板、血红蛋白减少不明显,术后1个月内两组各时间点对应白细胞减少比较无显著性差异(P>0.05)。完成全疗程化疗后,两组毒副反应发生情况基本相同。[结论]结直肠癌术后早期应用奥沙利铂联合5-Fu/甲酰四氢叶酸(FOLFOX方案)辅助化疗,不会影响患者切口愈合能力和增加术后并发症,对患者的功能恢复影响不大,对延长结直肠癌患者的生存期,减少术后复发可能会起到积极的作用。     

乳腺癌的内科治疗

乳腺癌经典手术后5年生存率78％，进展期乳腺癌长期生存甚微。新药紫杉醇类、诺维本、健择、阿霉素等药的联合化疗，明显地改善了晚期乳腺癌的生存质量。早期乳腺癌保乳手术辅助放疗、化疗、内分泌治疗是公认现代治疗模式。到目前为止，CMF、FAC方案仍为有效的辅助治疗方案。自体造血干细胞支持下的大剂量化疗能否延长生存仍有争议。而Herceptin单抗联合化疗是治疗上的一种重大进展。     

新辅助化疗FEC方案治疗妊娠期乳腺癌20例分析

[目的]评估新辅助化疗FEC方案治疗妊娠期乳腺癌临床价值。[方法]对确诊的妊娠期乳腺癌20例行FEC方案化疗3～4个周期后,行手术治疗,手术后病理检查并做免疫组化检测ER、PR和C-erbB-2。[结果]经FEC方案新辅助化疗后,90%肿瘤原发灶明显缩小,15%完全缓解。腋窝淋巴结阳性率下降,33.3%完全缓解;ER、PR和C-erbB-2结果与新辅助化疗前不符合,不符合率分别为35%、25%、35%。[结论]在妊娠期乳腺癌采用FEC方案新辅助化疗可降低病期、争取保乳机会,筛选敏感的化疗药物,但也会影响术后病理结果,ER、PR和C-erbB-2也可能发生变化。     

Adjuvant Chemotherapy for Early Stage Breast Cancer: Current Trends and Future Directions

Breast cancer is the most commonly diagnosed cancer among women in the United States. The goal of administering adjuvant therapy to women with early-stage breast cancer is to eradicate clinically occult micrometastatic disease that may later lead to distant recurrence and subsequent death from metastatic disease. Adjuvant chemotherapy has become an integral part of the treatment of early stage cancer. This review highlights some of the major advances in adjuvant chemotherapy, including choice of agents, scheduling, targeted therapy, and the use of molecular profiling techniques.