不同新辅助化疗方案治疗乳腺癌的临床观察

Clinical Evaluation of Three Different Regimens for Neoadjuvant Chemotherapy in the Treatment of Breast Cancer

目的比较3组不同新辅助化疗方案治疗乳腺癌的疗效及不良反应。方法Ⅱ、Ⅲ期乳腺癌68例随机分为3组,A组(FEC)24例、B组(ET)24例、C组(NE)20例,3组临床资料有可比性,分别用FEC、ET或NE化疗方案治疗,3～4周为一个周期。所有患者完成2周期新辅助化疗后评价疗效。结果乳腺癌原发肿瘤的总有效率(RR)A组为50%(12/24),B组RR为79.2%(19/24,与A组比较P<0.05),C组RR为75.0%(15/20,与A组比较P<0.05)。C组2例(10.0%)病理完全缓解(pCR),3组无进展病例,Ⅱ期疗效高于Ⅲ期。新辅助化疗前68例患侧腋窝均可触及肿大淋巴结,化疗2周期后A组、B组、C组分别有50.0%(12/24)、66.7%(16/24,与A组比较P<0.05)、60.0%(12/20,与A组比较P<0.05)腋窝未触及肿大淋巴结。主要不良反应白细胞下降、胃肠道反应3组相似,ET组脱发程度严重,并伴有关节肌肉疼痛。NE组不良反应以神经毒性和血管静脉炎较突出。结论3组新辅助化疗方案对乳腺癌的原发肿瘤及腋窝淋巴结转移灶均有效,不良反应均可耐受。B组及C组疗效及不良反应均高于A组。

Objective: To compare the efficacy and side effects with three different neoadjuvant chemotherapy regimens for the treatment of breast cancer. Methods: Six-eight patients with stage Ⅱ? Ⅲ breast cancer were divided into three groups at random, and received FEC, ET or NE regimen every 3-4 weeks for 2 cycles. Clinical responses in the breast and lymph nodes were assessed after 2 cycles of neoadjuvant chemotherapy. Results: For primary tumors of breast, the overall response rate(RR) was 50% (12/24) in FEC arm and 79% (19/24, P<0.05) in ET arm and 75% (15/20, P<0.05) in NE arm respectively. There were only 2 cases obtained pathologic complete response in NE arm and no progressive disease in three groups,and a higher proportion of RR was in stage Ⅱ rather than that in stage Ⅲ in three treatment groups. For all clinically involved auxilliary lymph nodes, 50% (12/24) in FEC arm and 67% (16/24, P<0.05) in ET arm and 60% (12/20, P<0.05) in NE arm were not palpable after 2 cycles neoadjuvant chemotherapy respectively. The major toxicities, including leukopenia, gastroenteric reactions, were similar in three groups,but alopecia was more severe and arthralgia, myalgia, neurotoxicity, and flushing of face were unique feature in ET regimens. Neurotocity and venous varsculitis were more obvious in NE regimens relatively. Conclusions: Neoadjuvant chemotherapy with three different regimens were all effective to primary tumors and axillary metastatic lymph nodes in breast cancer,and side effects were well tolerable. Better effects and more side effects have been observed in ET arm and NE arm than those in FEC arm.