自体外周血干细胞移植支持下的大剂量化疗在乳腺癌术前治疗中的应用

Preoperative high-dose chemotherapy with peripheral blood stem cell support in breast cancer: report of 3 cases

目的 观察自体外周血干细胞移植支持下的大剂量化疗 (HDC/APBSCT)在乳腺癌术前治疗中应用的可行性。 方法 本组 3例乳腺癌患者 ,分别为T3N1 M0 (Ⅲa 期 )、T4 N1 M0 (Ⅲb 期 )、T4 N1 M1 (Ⅳ期 ) ,均给予HDC/APBSCT治疗后 ,再予以手术。HDC/APBSCT实行过程为 :FEC方案诱导化疗 2个周期 ,结束后评定疗效 ;自体外周血干细胞动员、采集、冻存 ;大剂量化疗及APBSC回输支持治疗。 3例患者采用的治疗为 :环磷酰胺 2 5g/m2 、足叶乙甙 60 0mg/m2 和卡铂 60 0mg/m2 。HDC/APBSCT治疗后重新评定疗效 ,选择手术方案并实施。例 1行乳腺癌根治术、例 2行改良根治术 ,例 3行改良根治加大面积植皮术。 结果 HDC/APBSCT治疗后 4周 (例 1、例 2 )以及 33d后 (例 3)给予手术治疗。经观察对手术操作无明显影响 ,伤口愈合良好 ,其中例 3同时给予一期大面积植皮亦愈合良好。Ⅲa、Ⅲb 期 2例患者随访时间已超过 30个月至今健康生活。Ⅳ期患者术后 1 6个月死于脑部转移。 结论 HDC/APBSCT在乳腺癌术前治疗中具有一定可行性。

Objective To investigate the possibility and short term effect of high dose chemotherapy with peripheral blood stem cell support in the preoperative therapy of breast cancer, and its influence on the following operation and would healing. Methods Three patients with T 3N 1M 0(Ⅲ a), T 4N 1M 0(Ⅲ b), T 4N 1M 1 (Ⅳ) of breast cancer were diagnosed histopathologically. After receiving HDC/APBSCT, the 3 patients were operated on. HDC/APBSCT process included 2 cycles of FEC induction chemotherapy; PBSC mobilization, APBSC collection and cryopreservation and PBSC infusion;and high dose chemotherapy, APBSC infusion and supportive therapy. The therapy consisted of CTX2 5 g/m 2, VP 16 600 mg/m 2, and cerboplatin 600 mg/m 2 delivered on day 1, APBSC infusion 48 h later,rhG CSF (150 μg, BID ) was administered 4 h after infusion of APBSC until WBC was higher than 10×10 9/L. During HDC/APBSCT, the patients were protected in the air laminar flow room with supportive therapy of antibiotics, anti virus and anti fungus drugs. They left the air laminar flow room after their WBC was greater than 2×10 9/L. Case 1 was treated by radical mastectomy, Case 2 by improved radical mastectomy, Case 3 by improved radical mastectomy and transplantation of skin for the large area. Results Rapid recovery of bone marrow function was observed in all 3 patients. Operation was performed 4 weeks after HDC/PBSCT in Cases 1,2 and 33 days in Case 3. No influence was seen on operative procedure and would healing, especially in Case 3 with a large area of skin transplantation. Two patients with stage Ⅲ a and Ⅲ b have been alive since the treatment for 30 months and the other with stage Ⅳ died of brain metastasis 16 months later. Conclusions HDC/APBSCT as a preoperative therapy for breast cancer has no influence on the coming surgery and would healing, even on skin transplantation for a large area. It has a practical response in stageⅢ a and Ⅲ b, but it is still controversial in stage Ⅳ. This method as a salvage therapy for patients with breast cancer of intemuediate or stage.