多西他赛联合表柔比星、环磷酰胺和氟尿嘧啶治疗局部晚期乳腺癌

Docetaxel combined with Epirubicin and Cytoxan and 5-FU for locally advanced breast cancer neoadjuvant chemotherap

目的:观察多西他赛联合表柔比星、环磷酰胺、氟尿嘧啶(DECF方案)新辅助化疗治疗局部晚期乳腺癌(locally advanced breast cancer,LABC)疗效及毒副反应。方法:2005年8月—2007年9月收治的26例LABC患者,均为女性。中位年龄46岁(30～72岁),Ⅲa期16例,Ⅲb期10例,化疗剂量为多西他赛80mg/m2、表柔比星60mg/m2、环磷酰胺500mg/m2和氟尿嘧啶500mg/m2静脉滴入,每3周为1个周期,2个周期后评价疗效,并决定是否继续1～2个周期DECF方案后再接受手术或放疗。化疗后48h预防性应用细胞集落刺激因子(G-CSF)。结果:26例患者接受2～4个周期DECF方案的新辅助化疗。治疗后完全缓解5例,部分缓解15例,稳定4例,进展2例,有效率76.9%(20/26),病理完全缓解率、临床完全缓解率和临床部分缓解率分别为11.5%、19.2%和57.7%,本组的手术切除率为96%。主要毒副反应为白细胞减少,Ⅲ～Ⅳ度白细胞减少的发生率分别占总周期数的12.5%和15.0%,其他不良反应为轻、中度的脱发、恶心或呕吐、肌肉关节酸痛、体液潴留、疲乏、腹痛等。结论:DECF方案是LABC的一种安全有效的新辅助化疗方案。

Objective： To investigate the therapeutic effect and side reaction of new adjuvant chemotherapy with docetaxel （D） Epirubicin （E） cytoxan （D） 5-FU （F） for locally advanced breastcancer （LABC）. Methods： 26 women （2005.8-2007.9）with LABC were treated, median age was 46 （30-72age）.16 patients were in clinical stage Ⅲ a, 10 in stage Ⅲ b. The dosage were 80mg/m^2（Docetaxel）, 60 mg/m^2 （Epirubicin）, 500mg/m^2（cytoxan） and 500mg/m^2（25-FU） every 3 weeks. After 2-4 cycles of DECF application, the therapeutic effect and side reaction were evaluated by investigators for each patient to decide whether she should receive another t-2 cycles of DECF before re-surgery or radiation therapy. G-CSF was Prophylactically used at 48hs after chems. Results： 26 patients received 2-4 cycles of DECF protocol. （CR）5 cases, （PR）15 cases, （SD）2 cases, （PD）4cases, and the effective rate （CR＋PR） was 76.9% （20/26）.The pathological complete response （PCR）, clinical complete response （CCR） and clinical partial response （CPR） rates were 14.3%, 21.4% and 53.6% respectively. Tumor operation rate was 96% in this group. The major toxicity included neutropenia,and Grade Ⅲ -Ⅳneutropenia was 12.5% and 15.0% of the total cycle. The other adverse events were alopecia, nausea, vomiting, myalgia and arthralgia ,fluid retention, lassitude, abdominal pain ,which were mild to moderate. Conclusion： Docetaxel combined with Epirubicin and Cytoxan and 5-FU is effective and well-tolerated by women with locally advanced breast cancer.