临床ⅠⅡ期乳腺癌术前短程化疗的意义

Significance of short course preoperative chemotherapy in breast cancer of I and II clinical stage.

目的 探讨临床Ⅰ、Ⅱ期乳腺癌术前短程化疗的意义。方法 12 2例临床Ⅰ、Ⅱ期乳腺癌术前用CEF方案化疗 1疗程 ,化疗后 3～ 5d手术。结果 部分缓解 2 1例 (占 17 2 %) ,轻度缓解 76例 (占 6 2 3%) ,无变化 2 5例(占 2 0 5 %) ,无临床进展病例。术前可扪及腋窝肿大淋巴结 42例 ,化疗后 30例见淋巴结明显缩小或消失。病理组织学观察 75例镜下见肿瘤细胞有小点片状坏死。 10 6例按计划手术 ;16例因白细胞降低等化疗反应推迟手术。全组随访 1～ 6年 ,无局部复发病例 ;6例在随访期间 1～ 3年内发现骨转移 ,经放疗和化疗控制 ;仅 1例同时有骨转移和肺转移者于术后 4年死亡 ;余均健在。结论 可手术乳腺癌的术前短程化疗可观察到肿瘤缩小等治疗效果 ,为术后化疗提供指导。并可能减少术中血行转移和提高疗效。

Objective To evaluate the significance of short course preoperative chemotherapy in breast cancer of I and II clinical stage.Methods One hundred and twenty-two patients with stage I or II breast cancer were treated with cyclophosphamide,epirubicin and 5-fluorouracil for one cycle before operation,which was followed by operation 3-5 days later.Results Twenty-one patients (17.2%) achieved a partial response,76 patients (62.3%) achieved a mild response,25 patients had no change (20.5%),and no patients had the disease progression.Of the 42 patients with enlarged axillary nodes,the lymph nodes were decreased significantly or could not be palpated after chemotherapy in 30 patients.Seventy-five cases of tumor samples could be found with focus necrosis on pathological examination after surgery.One hundred and six patients received operation as planned.The operations were delayed in 16 cases because of the adverse drug reaction of chemotherapy such as leucocytopenia.There were no local-regional recurrence arising in the 1-6 years of follow-up.Six patients had been found with bone metastases in 1-3 years after the operation,which were controlled with radiotherapy and chemotherapy; only 1 patient died from bone and lung metastases in 4 years postoperatively, and the others survived.Conclusions The breast tumor become smaller after the short course preoperative chemotherapy,which could guide the chemotherapy after operation, reduce the metastasis in blood during operation and improve therapeutic effect.