Awrich A E, Peetz M E, Moseley H S, Keenan E, Davenport C E, Fletcher W S
J Surg Oncol. 1982 Sep;21(1):9-17. doi: 10.1002/jso.2930210104.
From 1965 to the present, 287 patients with advanced and metastatic carcinoma of the breast have been treated according to a uniform philosophy of sequential therapy. Surgical castration was the initial procedure for premenopausal women and for postmenopausal women with clinical or laboratory evidence of endocrine responsive tumors. Tumor progression following castration was treated with major endocrine ablation, either adrenalectomy or hypophysectomy. Patients who relapsed following major ablation were treated with antiestrogen therapy as it became available. Nonresponders to major ablation and patients relapsing after antiestrogen therapy were treated with combination chemotherapy including cytoxan, methotrexate, 5-fluorouracil, and vincristine followed by adriamycin alone or in combination. Progression following chemotherapy was treated with additive hormonal therapy. Radiation therapy was used throughout for the control of localized disease, usually following complete hormonal ablation, except in cases of brain and spinal metastatic disease. The median survival for the entire group was 40.5 months from the onset of metastatic disease. Patients who responded to both oophorectomy and major ablation had a median survival of 61 months, which compares favorably to survival of 14 to 22 months reported in major combination chemotherapy trials. Survival following this method of sequential therapy is superior to other plans of management.
从1965年至今，287例晚期和转移性乳腺癌患者按照统一的序贯治疗理念接受了治疗。手术去势是绝经前女性以及有内分泌反应性肿瘤临床或实验室证据的绝经后女性的初始治疗方法。去势后肿瘤进展则采用主要的内分泌去除术治疗，即肾上腺切除术或垂体切除术。主要去除术后复发的患者在有抗雌激素治疗时采用抗雌激素治疗。对主要去除术无反应的患者以及抗雌激素治疗后复发的患者采用联合化疗，包括环磷酰胺、甲氨蝶呤、5-氟尿嘧啶和长春新碱，随后单独或联合使用阿霉素。化疗后进展则采用附加激素治疗。除脑和脊髓转移疾病外，通常在完全激素去除术后，全程使用放射治疗来控制局部疾病。从转移性疾病开始，整个组的中位生存期为40.5个月。对卵巢切除术和主要去除术均有反应的患者中位生存期为61个月，与主要联合化疗试验报告的14至22个月的生存期相比更具优势。这种序贯治疗方法后的生存期优于其他治疗方案。
