表阿霉素联合紫杉醇密集化疗治疗晚期乳腺癌的临床研究

Clinical research of dose - dense combinated pharmorubicin with paclitaxel in advanced breast cancer treatment

目的:观察表阿霉素联合紫杉醇密集化疗治疗晚期乳腺癌的疗效和毒性副反应以及组织病理学改变。方法:选取病理检查证实的晚期乳腺癌患者38例,所有患者均有可评价病灶,治疗方案为表阿霉素50mg／m2,dl,静脉注射,紫杉醇175mg/ m2,d2,静脉注射,每2周为1个疗程,所有患者至少接受2-4个疗程的治疗后进行评估。结果:所有患者均受到随访,临床完全缓解率(CR)为10．5％,部分缓解率(PR)为71．1％,总有效率为81．6％。其中初治患者有效率24／26(92．3％)明显高于复治患者7／12(58．3％),两者差异有显著性(P<0．05);其中Ⅲ期者有效率20／21(95．2％)显著高于Ⅳ期者11/17(64．7％),两者差异有显著性(P<0．05)。白细胞下降、中性粒细胞减少症主要出现在Ⅲ、Ⅳ度毒性副反应中,分别为63．2％和71．1％; 7．9％的病人出现白细胞减少性发热,经过使用G-CSF和预防使用抗生素等,能够按计划完成化疗,无严重败血症事件发生, 无治疗相关死亡,其它如血小板减少、贫血、胃肠道反应、骨髓抑制、感觉异常、肝功能异常等大多在Ⅰ、Ⅱ度毒性副反应中,可以耐受。化疗后组织病理学明显改变,癌细胞变性,坏死,退行性改变,癌细胞减少,腺管样结构减少,间质纤维化,炎性细胞浸润。结论:表阿霉素联合紫杉醇密集化疗治疗晚期乳腺癌患者,缓解率较高、毒性副反应可耐受,降低分期,使无法切除乳腺癌的手术切除率增高。

Purpose：To observe curative effect and side reaction ,histopathology change of dose -dense combinated pharmorubicin with paclitaxel in advanced breast cancer treatment. Methods ：38 patients with advanced breast cancer diagnosed by pathology,which had evaluation index, pharmorubicin 50mg/m^2, d1, intravenous injection, paclitaxel 175 mg/m^2, d2, intravenous injection, every 2 weeks as 1 course of treatment,after accepted 2 -4 course of treatment,all patients were evaluated. Results： All patients were followed up, clinical complete remission（CR） 10.5%, clinical partial remission 71.1%, total effective rate 81.6%. effective rate in patents of initial treatment was much higher than that in patients of retreatmen; effective rate in patents of Ⅲ stage also was much higher than that in patients of Ⅳ stage; low leucocyte and Neutropenia appeared Ⅲ, Ⅳ side reaction, occupying respectively 63.2% and 71.1% ;7.9% patients febricity owing to low leucocyte were cured by G - CSF and antibiotics, all patients successfully accomplish chemotherapy. Other side reaction ,for instance thrombocytopenia,anaemia,nausea and vomiting etc, mostly displayed Ⅰ , Ⅱ toxic reaction,but they can be tolerated. After chemotherapy, cancer cells degeneration, cellular necrosis, retrogression and interstitial fibrosis, inflammatory cell infiltration are obviously changed. Conclusion ： dose - dense chemotherapy combinated pharmorubicin with paclitaxel in advanced breast cancer treatment, remission rate was much higher and remission rate can be tolerated.