Nieto Yago, Jones Roy B, Shpall Elizabeth J
Blood and Marrow Transplant Program, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B-190 Denver, CO 80262, USA.
Curr Opin Oncol. 2004 Mar;16(2):114-9. doi: 10.1097/00001622-200403000-00005.
Controversy has surrounded the use of high-dose chemotherapy for breast cancer for more than a decade. Numerous randomized trials have compared high-dose chemotherapy with standard-dose chemotherapy in metastatic breast cancer and high-risk primary breast cancer, defined by extensive axillary node involvement or inflammatory disease. The authors review the main research results of high-dose chemotherapy for breast cancer in 2002 to 2003.
Preliminary analyses of three randomized trials in metastatic breast cancer and seven in high-risk primary breast cancer have been reported during this period. An advantage in event-free survival has been observed in all three studies in metastatic disease and in four of the high-risk primary cancer trials, albeit with no impact on overall survival at short follow-up. These early results are consistent with the most recent Cochrane reviews, which included trials reported through mid 2002.
An early event-free survival advantage is apparent in favor of high-dose chemotherapy in both high-risk primary and metastatic breast cancer. Longer follow-up of those and most other trials is required to detect translation of the event-free survival differences into benefits in overall survival. High-dose chemotherapy remains a valid research strategy in event-free survival and high-risk primary breast cancer.
十多年来，高剂量化疗在乳腺癌治疗中的应用一直存在争议。众多随机试验比较了高剂量化疗与标准剂量化疗在转移性乳腺癌和高危原发性乳腺癌（以腋窝淋巴结广泛受累或炎性疾病为定义）中的疗效。作者回顾了2002年至2003年乳腺癌高剂量化疗的主要研究结果。
在此期间，已有三项转移性乳腺癌随机试验和七项高危原发性乳腺癌随机试验的初步分析报告。在所有三项转移性疾病研究以及四项高危原发性癌症试验中均观察到无事件生存期方面的优势，尽管在短期随访中对总生存期无影响。这些早期结果与最新的Cochrane综述一致，后者纳入了截至2002年年中报告的试验。
在高危原发性和转移性乳腺癌中，高剂量化疗明显具有早期无事件生存期优势。需要对这些试验以及大多数其他试验进行更长时间的随访，以确定无事件生存期差异是否能转化为总生存期的益处。高剂量化疗在无事件生存期和高危原发性乳腺癌方面仍是一种有效的研究策略。
