40例乳腺癌新辅助化疗的疗效观察

目的评价含紫杉类或葸环类药物在乳腺癌术前化疗中的疗效及副作用。方法2005年7月～2007年11月在我院治疗的40例Ⅰ～Ⅲ期原发乳腺癌患者，采用含紫杉类（TP或TE／TEC方案）或葸环类（EC／FEC方案）联合方案，术前化疗2～4个周期，33例患者接受手术，术后完成规定化疗，应用B超结合触诊判断临床疗效，观察近期疗效及毒副作用，应用x^2检验及单因素分析判定相关因素与疗效的关系。结果化疗前后中位肿瘤最大径分别为3．5厘米和2．0厘米（P=0．01），临床有效率82．5％（33／40），其中cCR7．5％（3／40）、cPR75％（30／40）、cSD15％（6／40）、cPD2．5％（1／40）。手术治疗33例，术后pCR9．1％（3／33），tpCR6．1％（2／33）。这些病例中，不同肿瘤大小、受体状况、CerbB-2表达、不同分化程度以及化疗方案之间的肿瘤缓解率并无统计学差异。化疗毒副作用主要为脱发、骨髓抑制、消化道反应、口腔溃疡及外周神经毒性，心脏毒性主要表现为心律增快、心电图改变，肝功损害少见。结论紫杉类及蒽环类药物联合方案用于浸润性乳腺癌的术前化疗，可有效控制肿瘤，毒副作用可耐受。

Assessment of neoadjuvant chemotherapy for breast cancer in 40 patients

Objective To assess the early response and toxicity of neoadjuvant chemotherapy in combination with taxanes or epirubicin in patients with breast cancer. Methods Totally 40 patients with operable stage Ⅰ-Ⅲ breast cancer were treated with neoadjuvant chemotherapy between July 2005 and December 2007. The regimens of neoadjuvant chemothery were： TP （docetaxel, cisplatin） ; PE （paclitaxel, epirubicin）; TE （DOX, EPI）; TEC （DOX, EPI, cyclophosphamide）; EC （EPI, CTX）; FEC （5- FU, EP1, CTX）. All patients received 2 -4 cycles of neoadjuvant chemotherapy, 33 of those received operation after 2 - 4 cycles of chemotherapy. Clinical response of neoadjuvant chemotherapy was evaluated in all patients by palpation and uhrasonography. Results The clinical response rate was 82. 5% （33/ 40） [7.5% （3/40） cCRand75% （30/40） cPR], 15% （6/40） cSD, 2.5% （1/40） cPD, after surgery pathology detection were 9.1% （/33） pCR and 6. 1% （2/33） tpCR. The median clinical tumor size was significantly diminished from 3.5cm to 2.0cm （P = 0.01 ） after neoadjuvant chemotherapy. Factors such as clinical tumor size, ER/PR and CerbB -2 status, differentiation, and different chemotherapy regimens were not significant predictors for the response of neoadjuvant chemotherapy. The most common toxic effects were alopecia, neutropenia, nausea/vomiting, dental ulcer, neurotoxicity,cardiotoxicity, and less hepatic lesion. The major cardiotoxicity was cardiopalmus and abnomal electrocardiogram and there was no toxic deaths. Conclusions Patients with stage Ⅰ-Ⅲ breast cancers can benefit from taxanes/epirubicin -based neoadjuvant chemotherapy with acceptable toxic profiles.