Marks L B, Halperin E C, Prosnitz L R, Ross M, Vredenburgh J J, Rosner G L, Peters W
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710.
Int J Radiat Oncol Biol Phys. 1992;23(5):1021-6. doi: 10.1016/0360-3016(92)90908-z.
Between 2/87 and 2/91, 49 women with operable breast cancer involving greater than or equal to 10 axillary nodes were treated following mastectomy, with four cycles of Cyclophosphamide, Adriamycin, 5FU, followed by high doses of Cyclophosphamide, Cisplatin, Carmustine (HDCT) with autologous bone marrow transplant support. Forty patients received local-regional radiotherapy (generally to the chest wall, internal mammary, supraclavicular, +/- axillary nodal areas; minimum 44-50 Gy, 1.8-2 Gy/fraction, +/- 10-15 Gy scar boost; standard radiation techniques). The first nine patients did not receive local-regional radiotherapy. Three developed a local-regional failure (6-12 months after HDCT); six are without evidence of disease. Local-regional radiotherapy (LR XRT) was delivered to the subsequent 40 patients following HDCT+autologous bone marrow transplant. Six received less than 44 Gy of the planned local-regional radiotherapy due to significant toxicity and one of these failed locally. Only one local failure was observed among the 34 patients who received greater than or equal to 44 Gy. Two additional patients developed distant metastases. None of these 40 patients have failed in the axilla despite the fact that the axilla was irradiated in only 18 cases. Overall, 36/40 (90%) of these patients are without evidence of disease 4-30 months following HDCT (approximately 10-36 months after mastectomy, median 22 months). Radiotherapy was interrupted or discontinued because of progressive dyspnea, thrombocytopenia, or neutropenia in nine patients. Further studies to determine the roles of local-regional radiotherapy and HDCT in the development of these toxicities are underway. These encouraging results suggest that HDCT + autologous bone marrow transplant+local-regional radiotherapy may improve the survival rate in these high risk patients. A national randomized study to test the efficacy of this HDCT regimen is currently underway (Cancer and Leukemia Group B#9082 and Southwest Oncology Group #9114).
在1987年2月至1991年2月期间，49例可手术切除的乳腺癌且腋窝淋巴结累及大于或等于10个的女性患者在乳房切除术后接受治疗，给予4个周期的环磷酰胺、阿霉素、5-氟尿嘧啶，随后给予高剂量的环磷酰胺、顺铂、卡莫司汀（HDCT）并辅以自体骨髓移植支持。40例患者接受了局部区域放疗（一般照射胸壁、内乳、锁骨上、±腋窝淋巴结区域；最小剂量44 - 50 Gy，每次分割剂量1.8 - 2 Gy，±10 - 15 Gy瘢痕追加剂量；采用标准放疗技术）。前9例患者未接受局部区域放疗。3例出现局部区域复发（HDCT后6 - 12个月）；6例无疾病证据。HDCT +自体骨髓移植后，对随后的40例患者进行了局部区域放疗（LR XRT）。6例因严重毒性反应接受的局部区域放疗剂量低于计划的44 Gy，其中1例局部复发。在接受大于或等于44 Gy放疗的34例患者中仅观察到1例局部复发。另外2例患者发生远处转移。尽管仅18例患者的腋窝接受了照射，但这40例患者中无一例腋窝复发。总体而言，这些患者中有36/40（90%）在HDCT后4 - 30个月无疾病证据（乳房切除术后约10 - 36个月，中位时间22个月）。9例患者因进行性呼吸困难、血小板减少或中性粒细胞减少而中断或停止放疗。正在进行进一步研究以确定局部区域放疗和HDCT在这些毒性反应发生中的作用。这些令人鼓舞的结果表明，HDCT +自体骨髓移植+局部区域放疗可能提高这些高危患者的生存率。一项全国性随机研究正在进行，以测试这种HDCT方案的疗效（癌症与白血病B组#9082和西南肿瘤学组#9114）。
