局部进展期乳腺癌不同方案新辅助化疗的临床研究

目的 评价局部进展期乳腺癌的两种不同方案的新辅助化疗的近期疗效及其毒性反应。方法 从2001年1月～2004年1月应用CEF、NEF两种不同化疗方案对68例局部进展期乳腺癌进行新辅助化疗。所有患者完成2个周期的新辅助化疗后评价疗效及毒性反应。结果原发灶有效率CEF、NEF两组分别为47．2％（17／36）和71．9％（23／32）；其中各有1例病理完全缓解者，两组均无进展者。腋窝淋巴结有效率CEF、NEF两组分别为63．9％（23／36）和87．5％（28／32）；新辅助化疗后CEF组有11例（30．6%），NEF组有17例（53．1%）未触及肿大淋巴结。两组均未见Ⅳ度毒性反应，白细胞下降、脱发及胃肠道反应两组程度相似。NEF组出现特有的神经毒性和周围静脉炎。结论 两种不同方案用于局部进展期乳腺癌的新辅助化疗均有较好的近期疗效，毒性反应均可耐受。与CEF组相比，NEF组原发灶和腋窝淋巴结疗效均优于CEF组，而且两组毒性反应相当。

Clinical study of different regimens as neoadjuvant chemotherapy for local advanced breast cancer

[Objective] To evaluate the efficacy and toxicity of two different regimens as neoadjuvant chemotherapy for local advanced breast cancer.[Methods] From January 2001 to January 2004,68 patients with stage IIb-III breast cancer were treated with one of two different regimens:CEF,NEF,for 2 cycles every 28 days.Accroding to the effect standard and toxic grading standard suggested by WHO,efficacy and safety were evaluated after 2 cycles of neoadjuvant chemotherapy.Patients in CEF regimen received combination of cyclophosphamide(CTX)500 mg/m2,d1,8;epirubincin(EPI)50 mg/m2,d1,8;5-fluorouracil(5-Fu)500 mg/m2,d1,8.Patients in NEF regimen received vinorelbine(NVB)30 mg/m2,d1,5;EPI 50 mg/m2,d1;5-Fu 500 mg/m2,d1,5.[Results] For primary tumor in the breast,the overall response rate(RR)was 47.2 %(17/36)in CEF regimen and 71.9 %(23/32)in NEF regimen.There was no disease progressive(PD)and one patient showed pathologic complete response(pCR)in both groups.For axillary lymph nodes,the overall response rate(RR)was 63.9 %(23/36)in CEF regimen and 87.5 %(28/32)in NEF regimen.Clinically palpable axillary lymph nodes which had been found in all 68 patients before treatment,30.6 %(11/36)in CEF regimen and 53.1%(17/32)in NEF regimen became impalpable.The major toxicity,including leukopenia,gastroenteric reactions and alopecia were similar in both groups,but neurotoxicity and milieu phlebitis were the unique side-effects of the NEF regimen.[Conclusion] Neoadjuvant chemotherapy with two different regimens was all effective to the primary tumor and axillary metastatic lymph nodes of local advanced breast cancer,and the side effects were tolerable.Comparing with CEF,NEF regimen has higher efficacy and equal side effects.