Zapf István, Tizedes György, Pavlovics Gábor, Kovács Gyula, Kálmán Endre, Szalai Gábor, Kövér Erika, Farkas Róbert, Horváth Ors Péter
Pécsi Tudományegyetem, Klinikai Központ Sebészeti Klinika 7624 Pécs Ifjúság út 13.
Magy Seb. 2011 Oct;64(5):223-8. doi: 10.1556/MaSeb.64.2011.5.1.
INTRODUCTION/AIM: The importance of preoperative neoadjuvant (NA) systemic treatment in operable breast cancer has significantly increased in the last few years. The aim of our retrospective study was to determine the effect of NA therapy in breast cancer patients treated in our unit and analyze radiological and pathological response rates in the context of surgical treatment.
One hundred and fourteen cases of breast cancer with NA therapy were analyzed and clinical data were collected from March 2007 to December 2010. Twenty-two patients received NA treatment for inoperable tumours. As far as operable cancers (92 patients), the indications for NA treatment were high tumour grade, presence of axillary metastasis and relatively young age. 5-Fluorouracil-Epirubicin-Cyclophosphamid or Taxotere-Epirubicin regimens were administered in 6 cycles followed by radiological evaluation and surgery. Herein, we compared the preoperative staging with the pathological results after surgery.
NA therapy resulted in complete regression in 17% of patients, significant regression in 21%, while moderate regression was achieved in 43% of patients. No regression was detected in 19%. The decrease in T stage was not followed by decrease in N stage in significant number of cases. Moreover, in some cases NA therapy caused complete radiological regression, while histologically it still remained positive. In certain cases, breast conserving surgery was feasible due to down-staging caused by NA therapy.
NA therapy was effective primarily in decreasing tumour size; however, it was less effective on axillary lymph node metastases. Due to the presence of the residual DCIS component, the volume of resection could not be decreased as much as down-staging of the invasive cancer would have permitted.
引言/目的：在过去几年中，术前新辅助（NA）全身治疗在可手术乳腺癌中的重要性显著增加。我们这项回顾性研究的目的是确定NA治疗对在我们科室接受治疗的乳腺癌患者的影响，并在手术治疗的背景下分析放射学和病理学缓解率。
分析了114例接受NA治疗的乳腺癌病例，并收集了2007年3月至2010年12月的临床数据。22例患者因肿瘤无法手术而接受NA治疗。对于可手术的癌症（92例患者），NA治疗的指征为肿瘤分级高、存在腋窝转移且年龄相对较小。采用5-氟尿嘧啶-表柔比星-环磷酰胺或多西他赛-表柔比星方案进行6个周期的治疗，随后进行放射学评估和手术。在此，我们将术前分期与术后病理结果进行了比较。
NA治疗使17%的患者完全缓解，21%的患者显著缓解，43%的患者中度缓解。19%的患者未检测到缓解。在相当数量的病例中，T分期降低但N分期未降低。此外，在某些病例中，NA治疗导致放射学完全缓解，但组织学上仍为阳性。在某些情况下，由于NA治疗导致分期降低，保乳手术是可行的。
NA治疗主要在减小肿瘤大小方面有效；然而，对腋窝淋巴结转移的效果较差。由于存在残留的导管原位癌成分，切除体积无法像浸润性癌分期降低所允许的那样大幅减少。
