可手术乳腺癌新辅助化疗后保乳手术的可行性研究

Feasibility of breast conservation surgery after neoadjuvant chemotherapy for breast cancer

目的探讨可手术乳腺癌新辅助化疗(NCT)后的疗效及原发肿瘤缩小后保乳手术的可行性。方法自2001年7月至2003年4月用表阿霉素60mg/m2,d1静注,紫杉醇150mg/m2,d2持续3h静滴,作为NCT方案治疗ⅡB和ⅢA期乳腺癌30例,21d为1个周期,术前共用3～4周期。化疗后肿瘤缩小至3cm以下者行保乳手术或改良根治术,无效者行改良根治术。结果乳腺癌原发肿瘤总有效率(ORR)为93%(28/30),15(50%)例临床完全缓解(cCR),7(23%)例病理完全缓解(pCR),13(43%)例临床部分缓解(cPR),2(7%)例无变化(nochange,NC),无进展病例。26(87%)例临床TNM分期达到了降期目的,NCT前原发肿瘤中位最大径4cm(范围3～10cm),化疗后中位最大径缩小至0.8cm(范围0～6cm)。30例均接受手术治疗,18(60%)例符合保乳适应症。11(37%)例行保乳手术。结论表阿霉素联合紫杉醇的NCT治疗可手术乳腺癌获得较高疗效,能明显地缩小甚至消灭乳腺癌的原发肿瘤,可以扩大保乳手术的适应证,使相当部分病人获得保乳的机会。

Objective To investigate the efficacy of neoadjuvant chemotherapy(NCT) and the feasibility of conservative breast surgery after reducing the size of a primary tumor by NCT in patients with operable breast cancer.Methods Thirty patients with stage ⅡB and ⅢA breast cancer underwent NCT including epirubicin 60 mg/m2 by intravenous injection on day 1 and paclitaxel 150 mg/m2 by 3-hour continuous infusion on day 2 with 21 days as a cycle from July 2001 to April 2003. All patients received 3~4 cycles of NCT. Breast conservation treatment or modified mastectomy was performed after the tumor was reduced to less than 3 cm in diameter. The nonresponders received modified mastectomy.Results The overall response rate(ORR) was 93% (28/30) for the primary tumors of breast, Fifteen patients (50%) obtained clinical complete response (cCR), including 7 cases (23%) with pathologic complete response (pCR). Thirteen cases (43%) achieved clinical partial response (cPR),and 2 (7%) no change(NC). No case showed progression of disease. Twenty-six (87%)cases were downstaged according to the TNM system classification. The median initial tumor size was 4 cm (3~10 cm) before NCT and was reduced to 0.8 cm (0~6 cm) after NCT. All 30 patients received operation. Eighteen (60%) of them were candidates for breast conserving therapy, and actually only 11 (37%) selected such surgery. Conclusion An effective treatment for operable breast cancer, NCT with epirubicin plus paclitaxel results in significant downstaging or eliminating of primary tumors in breast cancer, thus expanding the indication of breast conservation therapy.