Matsui Hiroto, Nagashima Atsushi, Kawaoka Toru, Hiraki Sakurao, Fukuda Shintaro
Department of Surgery, Ube Industries, Ltd., Central Hospital.
Gan To Kagaku Ryoho. 2009 Nov;36(12):2487-9.
The patient was a 79-year-old woman with the giant breast cancer accompanied with the invasion to pectoralis major muscle and skin. We worried that we would need a skin grafting for the operation because of a wide skin defect. So we performed FEC regimen (a combination of epirubicin, cyclophosphamide and 5-FU) as neoadjuvant chemotherapy (NAC) to reduce the tumor size. Adverse reaction were stomatitis of grade 2 and leukocytopenia of grade 3. The tumor size was reduced by about 25% and tumor marker decreased after 6-cycle of NAC. Then we performed a radical operation (Bt+Ax with partial resection of invaded part of pectoralis major muscle). It was simply difficult to close the skin, but we could close it without skin grafting by sliding BD area and axial skin flap. The pathological examination of resected specimens revealed scirrhous carcinoma with invasion to pectoralis major and skin, but no cancer cell was seen on the excised margin. There was no lymph node involvement. Her postoperative course was uneventful. On the 17th POD, she went back to her home and she now has been taking paclitaxel weekly as adjuvant chemotherapy at an outpatient clinic.
该患者为一名79岁女性，患有巨大乳腺癌，伴有胸大肌和皮肤侵犯。由于皮肤缺损范围广，我们担心手术需要进行皮肤移植。因此，我们采用FEC方案（表柔比星、环磷酰胺和5-氟尿嘧啶联合）作为新辅助化疗（NAC）以缩小肿瘤大小。不良反应为2级口腔炎和3级白细胞减少。经过6周期的NAC后，肿瘤大小缩小了约25%，肿瘤标志物下降。然后我们进行了根治性手术（乳房切除+腋窝清扫，胸大肌受侵部分部分切除）。缝合皮肤非常困难，但通过滑动BD区域和轴向皮瓣，我们能够在不进行皮肤移植的情况下将其缝合。切除标本的病理检查显示为硬癌，侵犯胸大肌和皮肤，但切除边缘未见癌细胞。无淋巴结受累。她的术后过程顺利。术后第17天，她回家了，现在在门诊每周接受紫杉醇辅助化疗。
