Kao Johnny, Conzen Suzanne D, Jaskowiak Nora T, Song David H, Recant Wendy, Singh Rachana, Masters Gregory A, Fleming Gini F, Heimann Ruth
Department of Radiation and Cellular Oncology, University of Chicago and Pritzker School of Medicine, Chicago, IL, USA.
Int J Radiat Oncol Biol Phys. 2005 Mar 15;61(4):1045-53. doi: 10.1016/j.ijrobp.2004.07.714.
The management of unresectable locally advanced breast cancer (ULABC) remains a major challenge because of the necessity both to treat local disease and to prevent distant disease. Two consecutive Phase I/II trials of concomitant chemotherapy and radiation (CRT) were performed to attempt to address both local and distant disease control in ULABC. This analysis focuses on rates of locoregional control and radiation-associated acute and late complications.
Thirty-three patients with unresectable locally advanced or inflammatory breast cancers (T4N0-3M0-1) or locally recurrent disease were treated with CRT on two consecutive Phase I/II trials. Radiotherapy consisted of 60-70 Gy to the breast or chest wall and 60 Gy to draining lymphatics in a week-on/week-off (WO/WO) schedule. Chemotherapy consisted of either continuous infusion or bolus paclitaxel +/- vinorelbine. A subset analysis of 16 patients with nonmetastatic ULABC Stage IIIB-C (T4N0-3M0) was performed. Among this cohort, 13 patients (81%) underwent planned mastectomy after CRT.
Of the 16 patients with Stage IIIB-C disease, acute toxicity included moist desquamation (n = 8) and Grade 3-4 neutropenia (n = 3). Late toxicity included breast reconstruction loss, decreased range of arm motion, lymphedema, and skin toxicity, although none was life-threatening. Of 15 assessable patients, 14 had a clinical response, 7 had a pathologic complete response (pCR) including 6 of 13 patients undergoing mastectomy. With a median follow-up for living patients of 43.8 months, the 4-year actuarial locoregional control, disease-free survival, and overall survival were 83%, 33%, and 56% respectively.
Concurrent WO/WO radiation therapy and paclitaxel +/- vinorelbine is effective locoregional therapy for ULABC with an acceptable toxicity profile. Further investigation of concurrent chemoradiotherapy in ULABC is warranted.
由于既要治疗局部疾病又要预防远处疾病，不可切除的局部晚期乳腺癌（ULABC）的管理仍然是一项重大挑战。进行了两项连续的同步放化疗（CRT）I/II期试验，试图解决ULABC的局部和远处疾病控制问题。本分析重点关注局部区域控制率以及放疗相关的急性和晚期并发症。
33例不可切除的局部晚期或炎性乳腺癌（T4N0 - 3M0 - 1）或局部复发性疾病患者在两项连续的I/II期试验中接受了CRT治疗。放疗包括每周一次/每周一次（WO/WO）方案，对乳房或胸壁给予60 - 70 Gy，对引流淋巴结给予60 Gy。化疗包括持续输注或大剂量紫杉醇±长春瑞滨。对16例非转移性ULABC IIIB - C期（T4N0 - 3M0）患者进行了亚组分析。在该队列中，13例患者（81%）在CRT后接受了计划性乳房切除术。
在16例IIIB - C期疾病患者中，急性毒性包括湿性脱皮（n = 8）和3 - 4级中性粒细胞减少（n = 3）。晚期毒性包括乳房重建失败、手臂活动范围减小、淋巴水肿和皮肤毒性，尽管均无生命危险。在15例可评估患者中，14例有临床反应，7例有病理完全缓解（pCR），其中13例接受乳房切除术的患者中有6例达到pCR。存活患者的中位随访时间为43.8个月，4年精算局部区域控制率、无病生存率和总生存率分别为83%、33%和56%。
同步WO/WO放疗和紫杉醇±长春瑞滨是治疗ULABC有效的局部区域治疗方法，毒性可接受。有必要对ULABC的同步放化疗进行进一步研究。
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