Swain S M, Sorace R A, Bagley C S, Danforth D N, Bader J, Wesley M N, Steinberg S M, Lippman M E
Cancer Res. 1987 Jul 15;47(14):3889-94.
We have treated 76 patients with locally advanced breast cancer, 31 with stage IIIA, 41 with stage IIIB, and 4 with stage IV disease, with primary induction chemotherapy including an attempted hormonal synchronization in 70 patients. All were treated to maximum objective clinical response before proceeding to any local therapy. Patients achieving a complete response with a negative repeat biopsy generally received radiation therapy while patients with residual disease, partial response (PR) or no change (NC) status received debulking surgery prior to radiation therapy. Regardless of response to induction chemotherapy, patients received at least 6 additional months of chemotherapy following local therapy. Initial doses of combination chemotherapy were escalated to targeted myelosuppression. The objective response rate to induction chemotherapy was 93% with 49% complete response (CR), 44% PR, and 7% NC. The median numbers of cycles of chemotherapy to achieve a CR, PR, or NC were 5, 3, and 5, respectively. Three patients who currently have PRs are still on chemotherapy with continued tumor regression. Of 37 patients achieving a CR to chemotherapy, 35 were assessed by biopsies to determine pathological evidence of response. Twenty-three of the 37 patients (62%) were proven to be complete responders with negative biopsies. Twenty-four patients have relapsed, 6 with stage IIIA, 16 with stage IIIB, and 2 with stage IV. Five patients have had locoregional relapses alone, 4 locoregional and distant, and 15 distant alone. Median time to progression is 35.9 months for stage IIIA and 34.2 months for stage IIIB. Median survival is 35.3 months for stage IIIB and is indeterminate for stage IIIA. This aggressive primary chemotherapy regimen with hormonal synchronization followed by local therapy appears to provide excellent local control and encouraging early results on systemic disease control.
我们对76例局部晚期乳腺癌患者进行了治疗，其中31例为IIIA期，41例为IIIB期，4例为IV期疾病，采用了包括70例患者尝试进行激素同步治疗的初始诱导化疗。所有患者在进行任何局部治疗之前均接受了最大程度的客观临床反应治疗。经重复活检为阴性而达到完全缓解的患者通常接受放射治疗，而有残留疾病、部分缓解（PR）或病情无变化（NC）的患者在放射治疗前接受减瘤手术。无论诱导化疗的反应如何，患者在局部治疗后均接受至少6个月的额外化疗。联合化疗的初始剂量逐步增加至目标性骨髓抑制。诱导化疗的客观缓解率为93%，其中完全缓解（CR）率为49%，PR率为44%，NC率为7%。达到CR、PR或NC的化疗周期中位数分别为5、3和5。目前有PR的3例患者仍在接受化疗，肿瘤持续消退。在37例化疗达到CR的患者中，35例通过活检进行评估以确定反应的病理证据。37例患者中有23例（62%）经活检证实为完全缓解者。24例患者复发，其中6例为IIIA期，16例为IIIB期，2例为IV期。5例患者仅发生局部区域复发，4例局部区域和远处复发，15例仅远处复发。IIIA期的中位进展时间为35.9个月，IIIB期为34.2个月。IIIB期的中位生存期为35.3个月，IIIA期不确定。这种采用激素同步治疗随后进行局部治疗的积极初始化疗方案似乎能提供出色的局部控制，并在全身疾病控制方面取得令人鼓舞的早期结果。
