Brito R A, Valero V, Buzdar A U, Booser D J, Ames F, Strom E, Ross M, Theriault R L, Frye D, Kau S W, Asmar L, McNeese M, Singletary S E, Hortobagyi G N
Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
J Clin Oncol. 2001 Feb 1;19(3):628-33. doi: 10.1200/JCO.2001.19.3.628.
To determine outcomes in local-regional control, disease-free survival, and overall survival in patients with locally advanced breast cancer (LABC) who present with ipsilateral supraclavicular metastases and who are treated with combined-modality therapy.
Seventy patients with regional stage IV LABC, which is defined by our institution as LABC with ipsilateral supraclavicular adenopathy without evidence of distant disease, received treatment on three prospective trials of neoadjuvant chemotherapy. All patients received neoadjuvant chemotherapy with cyclophosphamide, doxorubicin, and fluorouracil, or cyclophosphamide, doxorubicin, vincristine, and prednisone. Patients then received local therapy that consisted of either total mastectomy and axillary lymph node dissection (ALND) or segmental mastectomy and ALND before or after irradiation. Patients with no response to neoadjuvant chemotherapy were treated with surgery and/or radiotherapy. After completion of local therapy, chemotherapy was continued for four to 15 cycles, followed by radiotherapy. Patients older than 50 years who had estrogen receptor-positive tumors received tamoxifen for 5 years.
Median follow-up was 11.6 years (range, 4.8 to 22.6 years). Disease-free survival rates at 5 and 10 years were 34% and 32%, respectively. The median disease-free survival was 1.9 years. Overall survival rates at 5 and 10 years were 41% and 31%, respectively. The median overall survival was 3.5 years. The overall response rate (partial and complete responses) to induction chemotherapy was 89%. No treatment-related deaths occurred.
Patients with ipsilateral supraclavicular metastases but no other evidence of distant metastases warrant therapy administered with curative intent, ie, combined-modality therapy consisting of chemotherapy, surgery, and radiotherapy. Patients with ipsilateral supraclavicular metastases should be included in the stage IIIB category of the tumor-node-metastasis classification because their clinical course and prognosis are similar to those of patients with stage IIIB LABC.
确定出现同侧锁骨上转移且接受综合治疗的局部晚期乳腺癌（LABC）患者的局部区域控制、无病生存和总生存结局。
70例区域IV期LABC患者，我院将其定义为伴有同侧锁骨上腺病且无远处疾病证据的LABC，接受了三项新辅助化疗前瞻性试验的治疗。所有患者接受环磷酰胺、阿霉素和氟尿嘧啶或环磷酰胺、阿霉素、长春新碱和泼尼松的新辅助化疗。然后患者接受局部治疗，包括全乳切除和腋窝淋巴结清扫（ALND）或保乳手术和放疗前后的ALND。对新辅助化疗无反应的患者接受手术和/或放疗。局部治疗完成后，继续化疗4至15个周期，随后进行放疗。年龄大于50岁且雌激素受体阳性肿瘤患者接受他莫昔芬治疗5年。
中位随访时间为11.6年（范围4.8至22.6年）。5年和10年无病生存率分别为34%和32%。中位无病生存期为1.9年。5年和10年总生存率分别为41%和31%。中位总生存期为3.5年。诱导化疗的总缓解率（部分缓解和完全缓解）为89%。未发生与治疗相关的死亡。
有同侧锁骨上转移但无其他远处转移证据的患者应接受根治性治疗，即化疗、手术和放疗组成的综合治疗。有同侧锁骨上转移的患者应纳入肿瘤-淋巴结-转移分类的IIIB期，因为他们的临床病程和预后与IIIB期LABC患者相似。
