Shanta Viswanathan, Swaminathan Rajaraman, Rama Ranganathan, Radhika Ramachandran
Department of Breast and Gynaec Oncology, Cancer Institute, Gandhi Nagar, Adyar, Chennai, India.
Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):51-8. doi: 10.1016/j.ijrobp.2007.05.050. Epub 2007 Sep 14.
This was a retrospective observational study to elicit the outcome of the therapeutic strategy of concurrent neoadjuvant chemoradiotherapy protocol for locally advanced breast cancer.
A large series of 1,117 consecutive cases of locally advanced breast cancer treated at the Cancer Institute (WIA), in Chennai, South India, between 1990 and 1999 and followed through 2004 formed the basis for this study. Disease-free survival was the main outcome, and nodal and tumor downstaging were the intermediate outcome measures studied.
Primary tumor downstaging was observed in 45% and nodal downstaging in 57.5%. The disease-free survival rate of nodal downstaged patients at 5, 10, and 15 years was 75%, 65%, and 58%, respectively. The corresponding rates for pre- and postoperative node-negative patients were 70%, 60%, and 59%. The best survival was seen among those who were tumor and node negative postoperatively. Nodal downstaging halved the risk of disease recurrence and death compared with node positivity, irrespective of tumor sterility.
A randomized trial using cyclophosphamide, methotrexate, and 5-fluorouracil vs. an anthracycline-based regimen in the setting of concurrent chemoradiotherapy appears indicated. Additional preoperative chemotherapy to maximize nodal and tumor downstaging should be investigated. A change in postoperative chemotherapy according to nodal status could also be explored.
这是一项回顾性观察研究，旨在得出局部晚期乳腺癌同步新辅助放化疗方案的治疗策略结果。
1990年至1999年间在印度南部金奈癌症研究所（WIA）接受治疗并随访至2004年的1117例连续的局部晚期乳腺癌大样本病例构成了本研究的基础。无病生存是主要结局，而淋巴结和肿瘤降期是所研究的中间结局指标。
观察到原发肿瘤降期的比例为45%，淋巴结降期的比例为57.5%。淋巴结降期患者5年、10年和15年的无病生存率分别为75%、65%和58%。术前和术后淋巴结阴性患者的相应比例分别为70%、60%和59%。术后肿瘤和淋巴结均为阴性的患者生存率最高。与淋巴结阳性患者相比，无论肿瘤是否消退，淋巴结降期使疾病复发和死亡风险减半。
在同步放化疗背景下，采用环磷酰胺、甲氨蝶呤和5-氟尿嘧啶与基于蒽环类药物的方案进行随机试验似乎是有必要的。应研究额外的术前化疗以最大程度地实现淋巴结和肿瘤降期。也可以探索根据淋巴结状态改变术后化疗方案。
