Plasswilm L, Seegenschmiedt M H, Ganssauge F, Sauer R
Department of Radiation Oncology, University of Erlangen-Nürnberg, Germany.
Am J Clin Oncol. 1996 Aug;19(4):403-7. doi: 10.1097/00000421-199608000-00018.
Patients with locally recurrent and metastatic breast carcinoma require effective palliation of pain and complicating cutaneous, soft tissue, and lymph node metastases. Since October 1989, 48 consecutive patients with recurrent breast carcinoma after mastectomy and no further surgical option were entered in a phase I-II study comparing two radiochemotherapy (RCT) regimens. Treatment-related toxicity was analyzed in 48 patients together with short- and long-term efficacy in 44 patients who had a minimum follow-up of at least 1 year. Since October 1989, group A (28 patients) received 60 Gy "split-course" radiotherapy (RT) over 10 weeks with two breaks of 2 weeks each after the second and fourth week of RT. Simultaneous 5-fluorouracil, methotrexate, and cyclophosphamide (CMF) was given during RT. From October 1991 to April 1993, group B (20 patients) received 54-60 Gy "conventional" RT over 6 weeks. Simultaneous 5-fluorouracil/mitomycin C was applied in the first and fifth week. Overall response [complete response (CR) + partial response (PR)] was 82% in group A (CR, 21%). Five of 28 patients developed grade 3-4 toxicity (EORTC/RTOG/WHO). Overall response rate in group B was 87% (CR, 19%). In this group, 6 of 20 patients experienced grade 3-4 toxicities. In both groups, the rate of local response was remarkably lower in patients with distant metastases and a short relapse interval < 2 years. Although both regimens achieved a similar local response rate, group B patients experienced a higher toxicity rate than did group A patients, but the treatment duration was considerably shorter. The local tumor response was greatly influenced by the extent of systemic disease.
局部复发和转移性乳腺癌患者需要有效缓解疼痛以及处理皮肤、软组织和淋巴结转移等并发症。自1989年10月起，48例乳房切除术后复发且无进一步手术选择的乳腺癌患者连续进入一项I-II期研究，比较两种放化疗（RCT）方案。分析了48例患者的治疗相关毒性，以及44例至少随访1年患者的短期和长期疗效。自1989年10月起，A组（28例患者）在10周内接受60 Gy“分割疗程”放疗（RT），放疗第二周和第四周后各有2周的休息期。放疗期间同时给予5-氟尿嘧啶、甲氨蝶呤和环磷酰胺（CMF）。1991年10月至1993年4月，B组（20例患者）在6周内接受54 - 60 Gy“常规”放疗。在第一周和第五周同时应用5-氟尿嘧啶/丝裂霉素C。A组的总体缓解率[完全缓解（CR）+部分缓解（PR）]为82%（CR，21%）。28例患者中有5例出现3 - 4级毒性（欧洲癌症研究与治疗组织/美国放射肿瘤学会/世界卫生组织标准）。B组的总体缓解率为87%（CR，19%）。该组20例患者中有6例出现3 - 4级毒性。在两组中，远处转移且复发间隔短<2年的患者局部缓解率明显较低。尽管两种方案的局部缓解率相似，但B组患者的毒性发生率高于A组患者，但治疗持续时间明显更短。局部肿瘤反应受全身疾病程度的影响很大。
