Harris L, Swain S M
Vincent T. Lombardi Cancer Center, Georgetown University, Washington, DC, USA.
Semin Oncol. 1996 Feb;23(1 Suppl 2):31-42.
Primary chemotherapy was first attempted in the early 1970s in an attempt to improve local control and survival in patients with large breast tumors. While it is now clear that primary chemotherapy can achieve high response rates and allow more conservative surgery, it is less apparent if survival is improved in these patients. It is logical, then, to consider moving this form of treatment to an earlier stage of disease in which the probability of resistant clones is less in patients with lower tumor burden. Many questions still remain unanswered in the evaluation of the role of primary chemotherapy in the treatment of early breast cancer: Is the best method of diagnosis fine needle aspiration or incisional biopsy? What diagnostic tests are important before chemotherapy? Can better conservative local treatment be achieved using the primary modality of chemotherapy? Is local control, disease response, and/or survival improved by using chemotherapy before local measures? Several important studies have been performed in the treatment of early stage disease with primary chemotherapy and will be discussed with these questions in mind. In addition, investigation of markers that predict response to chemotherapy may help us better select patients who would benefit from primary chemotherapy. Those patients who are determined to have a poorer prognosis would be candidates for novel investigational treatments.
20世纪70年代初首次尝试进行原发性化疗，旨在提高大乳腺肿瘤患者的局部控制率和生存率。虽然现在很清楚原发性化疗可以实现高缓解率并允许进行更保守的手术，但这些患者的生存率是否提高尚不太明确。那么，将这种治疗方式应用于疾病的更早阶段是合乎逻辑的，在疾病早期，肿瘤负荷较低的患者中耐药克隆的可能性较小。在评估原发性化疗在早期乳腺癌治疗中的作用时，许多问题仍然没有答案：最佳的诊断方法是细针穿刺还是切取活检？化疗前哪些诊断测试很重要？使用原发性化疗方式能否实现更好的保守局部治疗？在采取局部措施之前使用化疗是否能改善局部控制、疾病缓解和/或生存率？已经进行了几项关于原发性化疗治疗早期疾病的重要研究，并将在考虑这些问题的情况下进行讨论。此外，对预测化疗反应的标志物的研究可能有助于我们更好地选择将从原发性化疗中受益的患者。那些被确定预后较差的患者将成为新型研究性治疗的候选者。
