Murakami M, Kuroda Y, Nishimura S, Sano A, Okamoto Y, Taniguchi T, Nakajima T, Kobashi Y, Matsusue S
Department of Radiology, Tenri Hospital. Tenri City, Nara Prefecture, Japan.
Am J Clin Oncol. 2001 Apr;24(2):185-91. doi: 10.1097/00000421-200104000-00017.
We analyzed response, side effects, and local control rates of a multimodal treatment consisting of intraarterial infusion chemotherapy (IAIC) and radiotherapy with or without surgery for patients with locally advanced or recurred breast cancer. Thirty-three patients, clinically diagnosed as stage IIB in 1, IIIA in 2, IIIB in 12, IV in 18, were treated from 1991 to 1998. Twenty-five were primary and eight were recurrent cases after surgery. IAIC started as initial treatment up to three times maximum. In most cases, doxorubicin 50 mg, cisplatin 50 mg, and mitomycin 10 mg were infused in the subclavian and/or internal mammary artery. After IAIC, patients in primary cases underwent radical mastectomy or breast conservation surgery, after radiotherapy at a total dose of 50 Gy/25 fractions/5 weeks with a boost of 10 Gy. In recurrent cases, a full dose of radiotherapy was delivered. Clinical objective and complete response rates were 78% and 9% after IAIC. Despite a high rate of residual positive margin (67%) or clinically residual carcinoma, local recurrence developed only in 2 patients (6%) and local control rates at 5 years were calculated as 89%. Bone marrow suppression was frequent, and skin vesiculation (15%) and ulceration (9%) were experienced after IAIC. Skin ulcer (6%), brachial plexus neuropathy (3%), and radiation pneumonitis (3%) occurred as late toxicity. IAIC was effective as an induction treatment and radiotherapy played a role of local control for patients with locally advanced or recurrent breast cancer.
我们分析了局部晚期或复发性乳腺癌患者接受动脉内灌注化疗（IAIC）联合放疗（加或不加手术）的多模式治疗的反应、副作用及局部控制率。1991年至1998年期间共治疗了33例患者，临床诊断为IIB期1例、IIIA期2例、IIIB期12例、IV期18例。其中25例为原发性病例，8例为术后复发病例。IAIC作为初始治疗，最多进行3次。多数情况下，将50毫克阿霉素、50毫克顺铂和10毫克丝裂霉素注入锁骨下动脉和/或乳内动脉。IAIC后，原发性病例患者接受根治性乳房切除术或保乳手术，放疗总剂量为50 Gy/25次/5周，追加剂量为10 Gy。复发病例则接受全剂量放疗。IAIC后的临床客观缓解率和完全缓解率分别为78%和9%。尽管切缘残留阳性率较高（67%）或存在临床残留癌，但仅2例（6%）出现局部复发，5年局部控制率计算为89%。IAIC后骨髓抑制较为常见，还出现了皮肤水疱（15%）和溃疡（9%）。皮肤溃疡（6%）、臂丛神经病变（3%）和放射性肺炎（3%）为晚期毒性反应。IAIC作为诱导治疗有效，放疗对局部晚期或复发性乳腺癌患者起到了局部控制作用。
