Darut-Jouve A, Coudert B, Jolimoy G, Belichard C, Arnoud L, Guerrin J
Centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21034 Dijon.
Bull Cancer. 1999 Feb;86(2):189-94.
The tolerance and the clinical and histological efficacy of a neoadjuvant chemotherapy FEC-HD including hematopoietic growth factors have been studied in 40 patients with stade II or III breast cancer between February 1991 and February 1997. Four courses were given, every 21 days, with 5-fluorouracil (750 mg/m2/day D1 to D4 by continuous infusion), epirubicin (35 mg/m2/day D2 to D4) and cyclophosphamide (400 mg/m2/day D2 to D4) with G-CSF (5 mug/kg/day D6 to D15). The surgery was performed 3 or 4 weeks after the end of the chemotherapy. All patients had radiotherapy. The neoadjuvant chemotherapy induced 37.5% CR, 45% PR, and 15% SD. In 40% of the patients, the surgery was conservative. An histological CR was obtained in 15% with no axillary involvement one time out of two. There was intraductal carcinoma without invasive carcinoma in 7.5%. There was no differences between the response of inflammatory and non inflammatory tumors. One hundred and fifty-eight courses have been delivered. A grade 3 or 4 leuconeutropenia, anemia and thrombopenia have been observed in respectively 34.6%, 6.3% and 8.8% of the courses. A grade 3 or 4 mucositis has been noticed in 2.5% of the courses. A febrile granulocytopenia has occurred in 3.8% of the courses. The median survival without metastatic progression was 48 months and the median overall survival was not achieved. In stade II and III breast cancer, neoadjuvant chemotherapy with FEC-HD obtains an important histological response with an acceptable toxicity. The role of the dose-intensity increase on survival remains to be determined.
1991年2月至1997年2月期间，对40例II期或III期乳腺癌患者研究了含造血生长因子的新辅助化疗方案FEC-HD的耐受性、临床及组织学疗效。每21天进行4个疗程，采用5-氟尿嘧啶（持续输注，750mg/m²/天，第1至4天）、表柔比星（35mg/m²/天，第2至4天）和环磷酰胺（400mg/m²/天，第2至4天）联合粒细胞集落刺激因子（5μg/kg/天，第6至15天）。化疗结束后3或4周进行手术。所有患者均接受放疗。新辅助化疗诱导37.5%的患者完全缓解（CR）、45%部分缓解（PR）和15%疾病稳定（SD）。40%的患者接受了保乳手术。15%的患者获得组织学CR，其中一半无腋窝淋巴结受累。7.5%的患者存在导管内癌而无浸润性癌。炎性肿瘤和非炎性肿瘤的反应无差异。共进行了158个疗程。分别有34.6%、6.3%和8.8%的疗程出现3或4级白细胞减少、贫血和血小板减少。2.5%的疗程出现3或4级粘膜炎。3.8%的疗程发生发热性粒细胞减少。无转移进展的中位生存期为48个月，总中位生存期未达到。在II期和III期乳腺癌中，FEC-HD新辅助化疗获得了重要的组织学反应且毒性可接受。剂量强度增加对生存的作用仍有待确定。
