老年性局部晚期乳腺癌术前内分泌治疗的临床应用

Clinical Application of Neo-adjuvant Endocrine Therapy for Locally Advanced Breast Cancer in Elderly Patients

目的探讨老年性乳腺癌术前内分泌治疗效果及降期后手术优点。方法 2004年5月2010年12月19例老年性局部晚期乳腺癌患者,术前给予口服芳香化酶抑制剂(aromatase inhibitors,AI)2～10个月,进行疗效观察,降期后手术及术后同一有效内分泌药物继续治疗并随访,时间1～66个月。结果自AI治疗开始至手术时,临床完全缓解2例,部分缓解11例,稳定3例,进展3例;手术14例,另5例由于全身状况差、基础疾病严重不能耐受手术或局部进展而放弃手术,5年总生存率68%,无瘤生存率47%。结论术前内分泌治疗疗效可靠,不良反应轻,特别适应老年伴有内科疾病不适应化学疗法的患者,可以增加保乳手术率和手术切除率。

Objective To investigate the clinical value of neo-adjuvant endocrine therapy for locally advanced breast cancer in elderly patients and the advantages of operation after down-staging of breast cancer.Methods From May 2004 to December 2010,19 patients with locally advanced breast cancer were treated with Aromatase inhibitor（AI） neo-adjuvant endocrine therapy for 2 to 10 months before operation.The clinical efficacy was observed.Operation was performed after down-staging of the cancer.After the operation,patients continued taking the same effective drug and were followed-up for 1 to 66 months.Results From AI treatment to the time of operation,there were 2 cases of clinical complete response,11 cases of clinical partial response,3 cases of stable disease,and 3 cases of progressive disease.A total of 14 patients were operated,and 5 other patients could not have the operation for bad body conditions,serious basic-diseases or local progress of the disease.The 5-year overall survival rate was 68%,and the disease-free survival rate was 47%.Conclusion Neo-adjuvant endocrine therapy has a reliable clinical effect and low side-effects.It is especially suitable for elderly patients excluded from chemotherapy because of internal medical diseases.It can also increase the rate of breast-conserving and surgical excision.