Asaishi K, Okazaki M, Okazaki A, Toda K, Masuoka H, Hirata K, Narimatsu E
Sapporo Kotoni Breast Clinic, Sapporo Medical University.
Gan To Kagaku Ryoho. 1994 Jun;21 Suppl 2:264-71.
Arterial infusion therapy with anticancer drugs is now attracting attention as a valuable modality for locally advanced breast cancer. Since 1977, we have used this therapy in 122 patients with primary breast cancer. The present report mainly discusses the clinical and histological response as well as the prognosis. The anticancer drugs were mainly given by two routes, infusion into the internal mammary artery and the subclavian artery. Continuous infusion of 5-FU and intermittent injections of MMC, ADR, 4'-epi-ADR and THP-ADR were jointly or individually made in each artery. Clinical response, defined as CR + PR, was noted in 48.4% of 5-FU group and 72.7% of ADR-MMC group. Histological response according to Shimosato Criteria, defined as grade IIb or better, appeared in 45.2% of main tumors and 25.4% of metastatic lymph nodes in the 5-FU group, and 70.9% main tumors and 46.3% of metastatic lymph nodes in the ADR-MMC group. The non-infusion group contained 27.7% of stage IIIb, against 72.2% in the infusion group. The 5-year overall survival rates were non-infusion group 62%, 5-FU group 34.1% and ADR-MMC group 66.2%. A significant difference was seen between the 5-FU infusion group and the ADR-MMC group (p = 0.03). Administration of high dose medroxy progesterone acetate for two weeks and 4'-epi-ADR infusion chemotherapy resulted in an excellent histological response. This combination therapy is a promising neoadjuvant chemo-endocrine therapy for advanced breast cancer.
动脉内灌注抗癌药物治疗作为局部晚期乳腺癌的一种有效治疗方式，目前正受到关注。自1977年以来，我们已将此疗法应用于122例原发性乳腺癌患者。本报告主要讨论临床和组织学反应以及预后情况。抗癌药物主要通过两种途径给药，即注入乳房内动脉和锁骨下动脉。在每条动脉中联合或单独进行5-氟尿嘧啶的持续灌注以及丝裂霉素C、阿霉素、表阿霉素和吡柔比星的间歇注射。临床反应（定义为完全缓解+部分缓解）在5-氟尿嘧啶组的48.4%患者以及阿霉素-丝裂霉素C组的72.7%患者中可见。根据下里标准定义的组织学反应（定义为IIb级或更好），在5-氟尿嘧啶组中，主瘤出现率为45.2%，转移淋巴结出现率为25.4%；在阿霉素-丝裂霉素C组中，主瘤出现率为70.9%，转移淋巴结出现率为46.3%。非灌注组IIIb期患者占27.7%，而灌注组为72.2%。5年总生存率在非灌注组为62%，5-氟尿嘧啶组为34.1%，阿霉素-丝裂霉素C组为66.2%。5-氟尿嘧啶灌注组与阿霉素-丝裂霉素C组之间存在显著差异（p = 0.03）。给予两周的大剂量醋酸甲羟孕酮和表阿霉素灌注化疗产生了良好的组织学反应。这种联合治疗是晚期乳腺癌一种有前景的新辅助化疗-内分泌治疗方法。
