Serin D, Aimard L, Kirscher S, Brewer Y, Félix-Faure C, Vincent P, Chauvet B, Reboul F
Unité de traitement des cancers du sein, Clinique Sainte-Catherine, Avignon, France.
Bull Cancer. 1997 Mar;84(3):247-53.
Adjuvant radiotherapy is the rule after conservative surgery for breast cancer. Furthermore, an anthracycline-based chemotherapy is recommended in node-positive patients and in poor prognosis tumors. The optimal schedule of treatment has yet to be determined, but ideally, none of these therapeutic modalities should be delayed. We have therefore conducted a feasibility trial using post-operative concurrent chemoradiation therapy with an anthracenedione. Between May 1990 and October 1994, 154 patients with stage I or II breast cancer who had benefited of either limited or radical surgery were treated with adjuvant concurrent chemoradiotherapy. Radiotherapy consisted of 50 Gy in 25 fractions over 5 weeks to the chest wall or the breast, and to the supraclavicular and internal mammary lymph nodes. When indicated, a boost of 15 Gy was then delivered to the primary tumor bed (n = 75). Starting on the first week of radiotherapy, combined chemotherapy with 5-fluorouracil, mitoxantrone, and cyclophosphamide was administered at 21-day intervals, for 4 to 6 cycles. Compliance to therapy was excellent. Median radiotherapy dose was 49.5 Gy to the chest wall or breast, and to the lymph nodes, and 14.2 Gy to the tumor bed. Chemotherapy was given at full dose in over 80% of the cases and the 21-day interval between cycles was respected in 31%. In 45% of the cases, a 28-day interval was required due to toxicity, and at least one interval longer than 28 days was necessary in the remainder of the patients. Main toxicities were nausea and vomiting (20.8%) and grade 3-4 neutropenia (12.3%). Grade 1 cutaneous toxicity occurred in 62.3% of the cases, and severe grade 3 radiation dermatitis requiring temporary interruptions of therapy in 4.5%. With the exception of one case of grade 3 acute cardiac toxicity, there was no other severe side-effects. In conclusion, this pilot study demonstrates the feasibility of concurrent chemoradiation therapy with an anthracenedione for stage I and II breast cancer in the adjuvant setting. Whether this approach compares favorably with standard sequential therapy in terms of long-term results remains to be determined and should be assessed in a phase III trial.
辅助放疗是乳腺癌保乳手术后的常规治疗手段。此外，对于淋巴结阳性患者和预后较差的肿瘤，推荐使用蒽环类药物进行化疗。治疗的最佳方案尚未确定，但理想情况下，这些治疗方式都不应延迟。因此，我们开展了一项可行性试验，采用术后同步放化疗联合蒽二酮治疗。1990年5月至1994年10月，154例I期或II期乳腺癌患者在接受了保乳手术或根治性手术后，接受了辅助同步放化疗。放疗方案为在5周内分25次给予胸壁或乳腺、锁骨上和内乳淋巴结50 Gy的剂量。如有需要，对原发肿瘤床追加15 Gy的剂量（n = 75）。从放疗的第一周开始，联合使用5-氟尿嘧啶、米托蒽醌和环磷酰胺进行化疗，每21天为一个周期，共进行4至6个周期。治疗依从性良好。胸壁或乳腺及淋巴结的中位放疗剂量为49.5 Gy，肿瘤床为14.2 Gy。超过80%的病例化疗剂量充足，31%的病例周期间隔为21天。45%的病例因毒性反应需要28天的间隔，其余患者至少需要一个超过28天的间隔。主要毒性反应为恶心和呕吐（20.8%）以及3-4级中性粒细胞减少（12.3%）。62.3%的病例出现1级皮肤毒性，4.5%的病例出现严重的3级放射性皮炎，需要暂时中断治疗。除1例3级急性心脏毒性外，无其他严重副作用。总之，这项初步研究证明了在辅助治疗中，蒽二酮同步放化疗用于I期和II期乳腺癌的可行性。这种方法在长期疗效方面是否优于标准序贯治疗仍有待确定，应在III期试验中进行评估。
