乳腺癌淋巴化疗与静脉化疗后腋窝淋巴结药物浓度的比较

Drug Concentration in Axillary Lymph Nodes of Patients with Breast Cancer after Lymphatic Chemotherapy

背景和目的:淋巴结状态是乳腺癌重要的预后因素之一,区域淋巴组织靶向化疗是近几年出现的针对高淋巴转移倾向肿瘤的治疗方法。本研究检测乳腺癌患者淋巴化疗(lymphaticchemotherapy,LC)后腋窝淋巴结内的药物浓度,并与静脉化疗(intravenouschemotherapy,VC)作对比,以确定LC能否有效提高区域淋巴结内抗癌药物的聚积。方法:60例乳腺癌患者随机分为LC组和VC组,每组30例,所有患者均于术前穿刺活检明确诊断。LC组在癌灶周围皮下注射卡铂鄄活性炭混悬液5mg/ml,VC组给予同等剂量卡铂水溶液静脉化疗。给药后1、12、24、36、48h分别行乳腺癌改良根治术,每组每个时间点各6例患者。术中常规清扫腋窝淋巴结并送病理检查,原子吸收光谱法(AAS)测定淋巴结内卡铂浓度。结果:术中共切除淋巴结275枚,其中LC组154枚,VC组121枚。共有23例(38.3%)患者的146枚(53.1%)淋巴结发现癌转移。LC组给药后1、12、24、36、48h腋窝淋巴结中卡铂浓度分别为(11.82±3.50)、(23.58±7.34)、(18.22±4.93)、(16.70±5.15)、(14.62±4.29)μg/g,VC组在给药后1、12、24、36h分别为(0.06±0.02)、(0.11±0.05)、(0.10±0.02)、(0.05±0.02)μg/g,给药后48h淋巴结内未检测出卡铂,两组间差异有极显著性(P<0.001)。

BACKGROUND & OBJECTIVE: Lymph node status is one of the decisive pro gnostic factors of breast cancer. Chemotherapy targeting regional lymphatic tiss ues has emerged as a promising therapy for malignancies with high tendency to di sseminate lymphatically. This study was to detect drug concentration in axillary lymph nodes of patients with breast cancer after lymphatic chemotherapy (LC), a nd to investigate effect of LC on accumulation of antitumor drugs in regional ly mph nodes through comparing with the effect of intravenous chemotherapy (VC). ME THODS: Sixty patients with breast cancer, confirmed by preoperative puncture bio psy, were ramdomized into 2 groups, 30 (LC group) were subcutaneously injected w ith 4 ml of carboplatin-activated carbon suspension (containing 20 mg of carbopl atin) around the primary tumor, the other 30 (VC group) were intravenously injec ted with an equal dose of aqueous carboplatin. Every 6 patients from each group received modified radical mastectomy 1, 12, 24, 36, or 48 h after injection. Axi llary lymph nodes were removed for pathologic examination. The concentration of carboplatin in nodes was detected by Zeeman atomic absorption spectrometry. RESU LTS: A total of 275 axillary lymph nodes were resected, with 154 in LC group and 121 in VC group. Of the 275 lymph nodes, 136(49.5%) were from 23 patients (38.3 %) had pathologically detected metastases. The concentrations of carboplatin wer e significantly higher in LC group than in VC group 1, 12, 24, 36, and 48 h afte r injection <(11.82±3.50) μg/g vs. (0.06±0.02) μg/g, (23.58±7.34) μg/g vs. (0.11±0.05) μg/g, (18.22±4.93) μg/g vs. (0.10±0.02) μg/g, (16.70±5.15) μg/g vs. (0.05±0.02) μg/g, and (14.62±4.29) μg/g vs. 0, respectively, P < 0 .001>. Lymph node metastasis had no correlation with drug concentration (P > 0.0 5). CONCLUSION: Compared with VC, LC can effectively and continuously improve dr ug concentration in axillary lymph nodes of patients with breast cancer.