Touboul E, Lefranc J P, Blondon J, Ozsahin M, Mauban S, Schwartz L H, Schlienger M, Laugier A, Guerin R A
Service de Cancérologie-Radiothérapie, Hôpital Tenon, Paris, France.
Radiother Oncol. 1992 Nov;25(3):167-75. doi: 10.1016/0167-8140(92)90263-t.
Between April 1982 and December 1987, 82 locally advanced non-metastatic and non-inflammatory breast cancers were treated (42 stage IIIA, 40 stage IIIB). The median follow-up is 70 months from the beginning of the treatment. The initial treatment consisted of 4 courses of chemotherapy (doxorubicin, vincristine, cyclophosphamide, 5-fluorouracil) followed by irradiation (45 Gy to the breast and nodal area). A fifth course of chemotherapy was given after radiation therapy. Three different locoregional approaches were proposed depending on the tumoral response. In 32 patients (39%) with residual tumor larger than 3 cm in diameter or located behind the nipple or with multifocal tumors, mastectomy and axillary dissection were performed. Fifty other patients (61%) benefited from conservative treatment: 32 patients (39%) achieved complete remission and received a boost to the initial tumor bed; 18 patients (22%) who had a residual mass less than or equal to 3 cm in diameter were treated by tumorectomy and axillary dissection followed by a boost to the tumorectomy site. After completion of local therapy, all patients received a sixth course of chemotherapy. A maintenance adjuvant chemotherapy regimen without anthracycline was prescribed (12 monthly cycles). Three- and 5-year disease-free survival rates were 81.7% and 72% respectively. Five-year locoregional relapse rate (with or without other sites of failure) was 8.8%. In a multivariate analysis, disease-free survival was significantly influenced by the N-stage (p < 0.0001), initial tumor size (p = 0.01), and tumor response after initial chemotherapy (p = 0.02). Five-year breast conservation probability was 58.4%.(ABSTRACT TRUNCATED AT 250 WORDS)
1982年4月至1987年12月期间，对82例局部晚期、非转移性且非炎性乳腺癌患者进行了治疗（42例为IIIA期，40例为IIIB期）。自治疗开始的中位随访时间为70个月。初始治疗包括4个疗程的化疗（多柔比星、长春新碱、环磷酰胺、5-氟尿嘧啶），随后进行放疗（乳腺及腋窝区域照射45 Gy）。放疗后给予第5个疗程的化疗。根据肿瘤反应提出了三种不同的局部区域治疗方法。对于32例（39%）残留肿瘤直径大于3 cm、位于乳头后方或为多灶性肿瘤的患者，实施了乳房切除术和腋窝淋巴结清扫术。另外50例（61%）患者接受了保乳治疗：32例（39%）达到完全缓解并对初始肿瘤床进行了追加放疗；18例（22%）残留肿块直径小于或等于3 cm的患者接受了肿瘤切除术和腋窝淋巴结清扫术，随后对肿瘤切除部位进行了追加放疗。局部治疗完成后，所有患者均接受了第6个疗程的化疗。开具了不含蒽环类药物的维持辅助化疗方案（每月1个周期，共12个周期）。3年和5年无病生存率分别为81.7%和72%。5年局部区域复发率（无论有无其他部位复发）为8.8%。多因素分析显示，无病生存受N分期（p<0.0001）、初始肿瘤大小（p = 0.01）和初始化疗后肿瘤反应（p = 0.02）的显著影响。5年保乳概率为58.4%。（摘要截取自250字）
