Jacquillat C, Baillet F, Auclerc G, Khayat D, Blondon J, Auclerc M F, Facchin T, Lefranc J P, Weil M
Drugs Exp Clin Res. 1986;12(1-3):147-52.
About 80% of patients with breast cancer ultimately die of metastatic disease at 20 years. Distant metastases are more important as a cause of death than local or regional relapses. It is for this reason that adjuvant chemotherapy is necessary, especially in young patients and those with extensive disease. Initial chemotherapy preceding any local or regional treatment is justified on the grounds that both surgery and anaesthesia lead to immunodepression. Further, the value of initial chemotherapy has been demonstrated in many experimental and clinical trials by Nissen-Meyer, Bonadonna and Cooper (1-3). In the present study 145 patients, including 67 with inflammatory breast cancer (IBC), were treated with 4-6 weeks of Velbe, thiotepa, methotrexate, fluorouracil and prednisone, with Adriblastin added for patients with IBC, T greater than 7 cm, or N2, N3. Because of tumour regression of greater than 50% observed in 80% of the patients, the majority (123 patients) then received radiotherapy alone (cobalt + iridium), resulting in complete remission in all these cases. Maintenance treatment with the same drugs was prescribed for 6-18 months depending on the initial stage. Tumour regression appears to be an important prognostic factor. Median follow-up is only 17 months, the longest being 42 months. Overall survival at 2 years for IBC is 90%, with a disease-free survival of 80%. Cosmetic results are excellent. While these results are encouraging, longer follow-up is needed to confirm this improvement.
约80%的乳腺癌患者最终会在20年内死于转移性疾病。远处转移作为死亡原因比局部或区域复发更为重要。正因如此，辅助化疗是必要的，尤其是在年轻患者和疾病广泛的患者中。在任何局部或区域治疗之前进行初始化疗是合理的，因为手术和麻醉都会导致免疫抑制。此外，Nissen-Meyer、Bonadonna和Cooper在许多实验和临床试验中证实了初始化疗的价值(1-3)。在本研究中，145例患者，包括67例炎性乳腺癌(IBC)患者，接受了4-6周的威猛（丙卡巴肼）、噻替哌、甲氨蝶呤、氟尿嘧啶和泼尼松治疗，对于IBC、肿瘤直径T大于7cm或N2、N3的患者加用阿霉素。由于80%的患者观察到肿瘤缩小超过50%，大多数患者(123例)随后仅接受了放疗(钴+铱)，所有这些病例均实现了完全缓解。根据初始分期，用相同药物进行6-18个月的维持治疗。肿瘤退缩似乎是一个重要的预后因素。中位随访时间仅17个月，最长42个月。IBC患者2年总生存率为90%，无病生存率为80%。美容效果极佳。虽然这些结果令人鼓舞，但需要更长时间的随访来证实这种改善。
