Pisansky T M, Loprinzi C L, Cha S S, Fitzgibbons R J, Grant C S, Hass A C, Reuter N F, Wold L E, Ingle J N, Kardinal C G
Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Cancer. 1996 Jun 15;77(12):2520-8. doi: 10.1002/(SICI)1097-0142(19960615)77:12<2520::AID-CNCR15>3.0.CO;2-U.
This prospective trial was conducted to evaluate the outcome of patients treated with preoperative and post operative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma.
Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor-positive tumors, was used after mastectomy. Post-operative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence.
Although 5 patients (7%) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65%). Sixty-eight patients (96%) underwent mastectomy. With a median follow-up of 52 months, the relapse-free and overall survival rates at 5 years were 42% and 57% respectively. Locoregional tumor recurrence occurred in 14 patients (20%), and 28 patients (39%) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome.
Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse-free and overall survival estimates for the approach described herein compared favorably with other comtemporary reports for this condition.
本前瞻性试验旨在评估接受术前和术后化疗、乳房切除术及放疗的局部晚期乳腺癌患者的治疗结果。
1986年6月至1990年9月期间，71例患者在乳房切除术前接受了2个周期的阿霉素与2个周期的环磷酰胺、甲氨蝶呤和5-氟尿嘧啶交替化疗；当肿瘤无法进行手术切除时进行放疗。乳房切除术后，对激素受体阳性肿瘤患者使用了额外的化疗和他莫昔芬。对局部疾病复发高危患者选择性地给予术后放疗。
尽管有5例患者（7%）出现疾病进展，但46例患者（65%）临床出现部分或完全肿瘤缓解。68例患者（96%）接受了乳房切除术。中位随访52个月，5年无复发生存率和总生存率分别为42%和57%。14例患者（20%）发生局部肿瘤复发，28例患者（39%）出现转移性疾病。绝经状态、临床表现（非炎性与炎性）以及美国癌症联合委员会临床分期是与患者预后相关的独立协变量。
术前交替化疗并选择性使用放疗可使局部疾病显著消退，并成功将乳房切除术纳入治疗策略。本文所述方法的局部肿瘤控制、无复发生存率和总生存率估计与该疾病的其他当代报道相比具有优势。
