Chen Jianghao, Wang Ling, Yao Qing, Ling Rui, Li Kaizong, Wang Hui
Department of Vascular and Endocrine Surgery, First Affiliated Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
Breast Cancer Res. 2004;6(4):R474-7. doi: 10.1186/bcr819. Epub 2004 Jun 17.
Lymph node status is one of the decisive prognostic factors in breast cancer. Chemotherapy targeting regional lymphatic tissues has emerged as a promising therapy for the treatment of malignancies with a high tendency to disseminate lymphatically. The present study determined the drug concentrations in axillary lymph nodes after lymphatic chemotherapy (LC) in patients with breast cancer and compared the results with those receiving intravenous chemotherapy (VC) to investigate whether LC could improve the accumulation of anticancer drug in regional lymph nodes.
Sixty patients with breast carcinoma confirmed by preoperative puncture-biopsy were divided into two groups at random. The LC group (n = 30) received a subcutaneous injection of 4 ml of carboplatin-activated carbon suspension, containing 20 mg of carboplatin, adjacent to the primary tumour. The VC group (n = 30) received an intravenous administration of an equal dose of aqueous carboplatin. At 1, 12, 24, 36 and 48 hours after administration, modified radical mammectomies were performed on 12 patients at each time point, with 6 from each group. Axillary lymph nodes were removed for pathological examination. The platinum concentrations in nodes were determined by Zeeman atomic absorption spectrometry.
A total of 275 axillary lymph nodes were resected, with 154 in the LC group and 121 in the VC group. Of the 275 lymph nodes, 136 (49.5%) from 23 patients (38.3%) had histopathologically detected metastases. At 1, 12, 24, 36 and 48 hours after injection, the carboplatin concentrations in the LC group were 11.82 +/- 3.50, 23.58 +/- 7.34, 18.22 +/- 4.93, 16.70 +/- 5.15 and 14.62 +/- 4.29 microg/g (means +/- SD), respectively, whereas those in the VC group were 0.06 +/- 0.02, 0.11 +/- 0.05, 0.10 +/- 0.02, 0.05 +/- 0.02 and 0 microg/g, respectively. Significant differences were found in each corresponding comparison (P < 0.001). Lymph node metastasis was uncorrelated with drug concentration (P > 0.05).
LC can effectively and continuously improve the drug concentrations in axillary lymph nodes in patients with breast cancer, in comparison with VC.
淋巴结状态是乳腺癌决定性的预后因素之一。针对区域淋巴组织的化疗已成为一种有前景的治疗方法，用于治疗具有高淋巴转移倾向的恶性肿瘤。本研究测定了乳腺癌患者淋巴化疗（LC）后腋窝淋巴结中的药物浓度，并将结果与接受静脉化疗（VC）的患者进行比较，以研究LC是否能提高抗癌药物在区域淋巴结中的蓄积。
60例经术前穿刺活检确诊的乳腺癌患者随机分为两组。LC组（n = 30）在原发肿瘤旁皮下注射4 ml含20 mg卡铂的卡铂活性炭混悬液。VC组（n = 30）静脉注射等量的卡铂水溶液。给药后1、12、24、36和48小时，在每个时间点对12例患者进行改良根治性乳房切除术，每组各6例。切除腋窝淋巴结进行病理检查。采用塞曼原子吸收光谱法测定淋巴结中的铂浓度。
共切除275个腋窝淋巴结，LC组154个，VC组121个。在275个淋巴结中，23例患者（38.3%）的136个（49.5%）有组织病理学检测到的转移。注射后1、12、24、36和48小时，LC组卡铂浓度分别为11.82±3.50、23.58±7.34、18.22±4.93、16.70±5.15和14.62±4.29μg/g（均值±标准差），而VC组分别为0.06±0.02、0.11±0.05、0.10±0.02、0.05±0.02和0μg/g。各对应比较均有显著差异（P < 0.001）。淋巴结转移与药物浓度无关（P > 0.05）。
与VC相比，LC能有效且持续地提高乳腺癌患者腋窝淋巴结中的药物浓度。
