自体外周血干细胞移植支持下的大剂量化疗在乳腺癌术前治疗中的应用

目的：观察自体外周血干细胞移植支持下的大剂量化疗（HDC／APBSCT）在乳腺癌术前治疗中应用的可行性。方法：本组3例乳腺癌患者,分别为T3N1M0（Ⅲa期）、T4N1M0（Ⅲb期）、T4N1M1（Ⅳ期）,均给予HDC／APBSCT治疗后,再予以手术。HDC／APBSCT实行过程为：FEC方案诱导化疗2个周期,给后评定疗效;自体外周血干细胞动员、采集、冻存;大剂量化疗及APBSC回输支持治疗。3例患者采用的治疗为：环磷酰胺2．5g/m^2、足叶乙甙600mg/m^2和卡铂600mg/m^2。HDC／APBSCT治疗后重新评定疗效,选择手术方案并实施。例1行乳腺癌根治术、例2行改良根治术,例3行改良根治加大面积植皮术。结果：HDC／APBSCT治疗后4周（例1、例2）以及33d后（例3）给予手术治疗。经观察对手术操作无明显影响,伤口愈合良好,其中例3同时给予一期大面积植皮亦愈合良好。Ⅲa、Ⅲb期2例患者随访时间已起过30个月至今健康生活。Ⅳ期患者术后16个月死于脑部转移。结论：HDC／APBSCT在乳腺癌术前治疗中具有一定可行性。将该方法做为中晚期乳腺癌患者的一种可供选择的抢救性治疗措施是值得偿试的。

Preoperative high-dose chemotherapy with peripheral blood stem cell support in breast cancer: report of 3 cases

OBJECTIVE: To investigate the possibility and short-term effect of high dose chemotherapy with peripheral blood stem cell support in the preoperative therapy of breast cancer, and-its influence on the following operation and would healing. METHODS: Three patients with T(3)N(1)M(0) (III(a)), T(4)N(1)M(0) (III(b)), T(4)N(1)M(1) (IV) of breast cancer were diagnosed histopathologically. After receiving HDC/APBSCT, the 3 patients were operated on. HDC/APBSCT process included 2 cycles of FEC induction chemotherapy; PBSC mobilization, APBSC collection and cryopreservation and PBSC infusion; and high-dose chemotherapy, APBSC infusion and supportive therapy. The therapy consisted of CTX2.5 g/m(2), VP-16 600 mg/m(2), and cerboplatin 600 mg/m(2) delivered on day 1, APBSC infusion 48 h later, rhG-CSF (150 microg, BID) was administered 4 h after infusion of APBSC until WBC was higher than 10 x 10(9)/L. During HDC/APBSCT, the patients were protected in the air laminar flow room with supportive therapy of antibiotics, anti-virus and anti-fungus drugs. They left the air laminar flow room after their WBC was greater than 2 x 10(9)/L. Case 1 was treated by radical mastectomy, Case 2 by improved radical mastectomy, Case 3 by improved radical mastectomy and transplantation of skin for the large area. RESULTS: Rapid recovery of bone marrow function was observed in all 3 patients. Operation was performed 4 weeks after HDC/PBSCT in Cases 1, 2 and 33 days in Case 3. No influence was seen on operative procedure and would healing, especially in Case 3 with a large area of skin transplantation. Two patients with stage III(a) and III(b) have been alive since the treatment for 30 months and the other with stage IV died of brain metastasis 16 months later. CONCLUSIONS: HDC/APBSCT as a preoperative therapy for breast cancer has no influence on the coming surgery and would healing, even on skin transplantation for a large area. It has a practical response in stage III(a) and III(b), but it is still controversial in stage IV. This method as a salvage therapy for patients with breast cancer of intemuediate or stage.