Zhou Bo, Yang De-qi, Qiao Xin-min, Tong Fu-zhong, Cao Ying-min, Liu Peng, Liu Hong-jun
Department of Surgery, People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Yi Xue Za Zhi. 2005 Mar 23;85(11):769-72.
To investigate the efficacy of neoadjuvant chemotherapy (NCT) and the feasibility of conservative breast surgery after reducing the size of a primary tumor by NCT in patients with operable breast cancer.
Thirty patients with stage IIB and IIIA breast cancer underwent NCT including epirubicin 60 mg/m(2) by intravenous injection on day 1 and paclitaxel 150 mg/m(2) by 3-hour continuous infusion on day 2 with 21 days as a cycle from July 2001 to April 2003. All patients received 3 - 4 cycles of NCT. Breast conservation treatment or modified mastectomy was performed after the tumor was reduced to less than 3 cm in diameter. The nonresponders received modified mastectomy.
The overall response rate (ORR) was 93% (28/30) for the primary tumors of breast, Fifteen patients (50%) obtained clinical complete response (cCR), including 7 cases (23%) with pathologic complete response (pCR). Thirteen cases (43%) achieved clinical partial response (cPR), and 2 (7%) no change (NC). No case showed progression of disease. Twenty-six (87%) cases were downstaged according to the TNM system classification. The median initial tumor size was 4 cm (3 - 10 cm) before NCT and was reduced to 0.8 cm (0 - 6 cm) after NCT. All 30 patients received operation. Eighteen (60%) of them were candidates for breast conserving therapy, and actually only 11 (37%) selected such surgery.
An effective treatment for operable breast cancer, NCT with epirubicin plus paclitaxel results in significant downstaging or eliminating of primary tumors in breast cancer, thus expanding the indication of breast conservation therapy.
探讨新辅助化疗（NCT）对可手术乳腺癌患者的疗效，以及NCT使原发肿瘤缩小后行保乳手术的可行性。
2001年7月至2003年4月，30例IIB期和IIIA期乳腺癌患者接受NCT，方案为第1天静脉注射表柔比星60mg/m²，第2天3小时持续输注紫杉醇150mg/m²，21天为1个周期。所有患者接受3 - 4个周期的NCT。肿瘤直径缩小至3cm以下后行保乳治疗或改良根治术。无反应者行改良根治术。
乳腺癌原发肿瘤的总缓解率（ORR）为93%（28/30），15例（50%）获得临床完全缓解（cCR），其中7例（23%）为病理完全缓解（pCR）。13例（43%）达到临床部分缓解（cPR），2例（7%）无变化（NC）。无病例出现疾病进展。根据TNM系统分类，26例（87%）分期降低。NCT前原发肿瘤中位大小为4cm（3 - 10cm），NCT后缩小至0.8cm（0 - 6cm）。30例患者均接受了手术。其中18例（60%）适合保乳治疗，但实际仅11例（37%）选择了此类手术。
表柔比星联合紫杉醇的NCT是可手术乳腺癌的有效治疗方法，可使乳腺癌原发肿瘤显著降期或消除，从而扩大了保乳治疗的适应证。
