局部进展期乳腺癌新辅助化疗后保乳手术31例报告

Treatment of locally advanced breast cancer with breast-conserving therapy after neoadjuvant chemotherapy: Report of 31 cases

目的探讨局部进展期乳腺癌新辅助化疗降期后保乳手术治疗的可行性。方法2002年1月-2005年6月我院接受新辅助化疗后行保乳治疗的31例局部进展期乳腺癌。化疗方案：①TE：表阿霉素60mg／m^2，紫杉醇150mg／m^2，21d为1个周期；②CEF：表阿霉素60mg／m^2，环磷酰胺600mg／m^2，5-FU600mg／m^2，21d为1个周期，共3～4周期。在新辅助化疗完成后，临床体检、B超和钼靶乳房x线检查评估新辅助化疗疗效，符合保乳条件且病人有保留乳房的愿望可接受保乳治疗。手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清扫。术后常规行辅助放疔、化疗和内分泌治疗。结果新辅助化疗总有效率（overaul response rate，ORR）90．3％（28／31）；临床完全缓解（complete response，CR）25．8％（8／31），其中病理完全缓解（pathologic complete response，pCR）4例（12．9％，4／31），临床部分缓解（partial response，PR）20例（64．5％，20／31），无进展病例。经过34个月中位随访期（4～46个月），局部复发率6．5％（2／31）；3例术后发生远处转移，转移部位分别为肺、肝脏、脑膜和骨，远处转移率9．7％（3／31），其中1例死亡。对保乳综合治疗结束后满1年的25例进行乳腺外形的评估，外形优16．0％（4／25），良40．0％（10／25），差44．0％（11／25）。结论经新辅助化疗降期后的局部进展期乳腺癌进行保乳手术治疗效果满意，规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键。

Objective To investigate the feasibility of breast - conserving therapy （BCT） for locally advanced breast cancer after neoadjuvant chemotherapy （NAC）. Methods A total of 31 patients with locally advanced breast cancer underwent breast - conserving therapy after neoadjuvant chemotherapy in this hospital from January 2002 to June 2005. Treatment with neoadjuvant chemotherapy consisted of： ~）paclitaxel and epirubicin （TE） regimen - that is, intravenous epirubicin 60 mg/m^2 on day 1 and intravenous paclitaxel 150 mg/m^2 for 3 hours＇ continuous infusion on day 2 ; or （2）cyclophosphamide, epirubicin, and 5 - Fluorouracil （CEF） regimen - that is, intravenous cyclophosphamide 600 mg/m^2 and epirubicin 60 mg/m^2 on day 1, and intravenous 5 - fluorouracil 600 mg/m^2 for 4 hours＇ continuous infusion on day 1. The neoadjuvant chemotherapy was repeated every 21 days, for 3 - 4 cycles. Outcomes of the neoadjuvant chemotherapy were evaluated using physical examinations, B - uhrasonography, and molybdenum target roentgenography. Patients eligible for breast - conserving therapy were given quadrantectomy or wide excision of tumor plus axillary lymph node dissection, Adjuvant irradiation, chemotherapy and hormone therapy were given postoperatively. Results The overall response rate （ORR） was 90.3% （28/31） for the primary tumor of breast, Eight patients （25.8%） obtained clinical complete response （ cCR）, including 4 patients （ 12.9% ） with pathological complete response （pCR）. Twenty patients （64.5%） achieved clinical partial response （cPR）. No progression of disease （PD） was observed. Follow - up for 4 - 46 months （median, 34 months） showed a local recurrence rate of 6.5% （2/31）. Distant metastasis to the lung, liver, meninges, and bone occurred in 3 patients （9.7% , 3/31） and 1 of them died. Assessment of cosmetic results was carried out in 25 patients who had received breast- conserving therapy 〉 12 months postoperatively, and excellent results were obtained in 16.0% of the patients （4/25）, good in 40.0% （ 10/25 ）, and poor in 44.0% （ 11/25 ）. Conclusions For patients with locally advanced breast cancer previously treated with downstaging neoadjuvant chemotherapy, breast - conserving therapy offers satisfactory results. Strict adherence to technique and use of postoperative irradiation and systemic therapy are crucial to breast - conserving therapy.