Hojo Shigeyuki, Yoshioka Setsuko, Wakabayashi Yukiko
Dept. of Breast and Endocrine Surgery, Saiseikai Senri Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1594-1596.
We report a case performed mastectomy to tumor progression of breast cancer omitting surgery after neoadjuvant chemotherapy. A 62-year-old female patient visited our hospital for left breast tumor. A tumor of the size of 26×24 mm was found at between lower and upper outer quadrant, and we diagnosed it as breast cancer(cT1, cN2, M0, Stage ⅢA, ER positive/HER2 positive). Neoadjuvant chemotherapy by triweekly trastuzumab and weekly paclitaxel followed by EC chemotherapy were performed. However, she rejected surgery after neoadjuvant chemotherapy, and although we consequently restarted a regimen of triweekly trastuzumab which she also refused to continue after 9 cycles. 32 months later, she noticed induration on her left breast, and we diagnosed it as tumor progression of breast cancer. After obtaining informed consent, we performed total mastectomy and axillary lymph node dissection. Histological diagnosis revealed invasive ductal carcinoma, ER negative/HER2 positive, and no axillary lymph node metastasis. So far omission of surgery after neoadjuvant chemotherapy to breast cancer is not defined yet, and we expect early definition of evidence.
我们报告了一例因新辅助化疗后乳腺癌肿瘤进展而省略手术直接进行乳房切除术的病例。一名62岁女性患者因左乳腺肿瘤前来我院就诊。在乳腺外下象限与外上象限之间发现一个大小为26×24mm的肿瘤，我们将其诊断为乳腺癌（cT1，cN2，M0，ⅢA期，雌激素受体阳性/人表皮生长因子受体2阳性）。给予每三周一次曲妥珠单抗联合每周一次紫杉醇的新辅助化疗，随后进行EC化疗。然而，新辅助化疗后她拒绝手术，因此我们重新开始每三周一次的曲妥珠单抗治疗方案，但9个周期后她也拒绝继续治疗。32个月后，她发现左乳变硬，我们诊断为乳腺癌肿瘤进展。在获得知情同意后，我们进行了全乳房切除术和腋窝淋巴结清扫术。组织学诊断显示为浸润性导管癌，雌激素受体阴性/人表皮生长因子受体2阳性，且无腋窝淋巴结转移。目前，新辅助化疗后省略乳腺癌手术的情况尚无明确界定，我们期待能早日明确相关证据。
