Hamazoe R, Takahashi S, Sumi K, Murata Y, Kinugasa Y, Shiota S, Hirooka Y
Dept. of Surgery, Yonago Hakuai Hospital, Tottori University.
Gan To Kagaku Ryoho. 1998 Jul;25(9):1344-7.
Bone metastasis of breast cancer generally tends to be multiple. However, breast cancer frequently metastasizes to the sternum as solitary metastasis. Resection of the sternum was reported to be an effective surgical technique for sternum metastasis which could not be remarkably improved by chemo-endocrine therapy and locoregional recurrent breast cancer invading the skin. A first patient was diagnosed with sternum metastasis invading the skin 44 months after radical mastectomy for breast cancer of stage II. A second patient had breast cancer of stage IV simultaneously with metastases to the sternum and the lung. Only the lung metastasis was successfully controlled by chemo-endocrine therapy, but the sternum metastasis was progressive, following radical mastectomy. Both patients manifested solitary bone metastases and underwent full-thickness chest wall resection. The defect of the chest wall was reconstructed with the mucocutaneous flap using the dorsal latissimus muscle in case 1 and with the abdominal rectus muscle in case 2. Twenty months after the resection of the sternum, the first patient suffered from supraclavicular lymph node metastasis, and the multidisciplinary treatment including radiation therapy was indicated. This therapeutic procedure was effective, and the patient survived for 63 months after resection of the sternum. The second patient has made good progress for six months in maintaining complete remission with chemo-endocrine therapy. These findings suggested that surgical resection was a useful local treatment for solitary sternum metastasis.
乳腺癌骨转移通常倾向于多发。然而，乳腺癌常以孤立转移灶的形式转移至胸骨。据报道，对于化疗 - 内分泌治疗及局部复发侵犯皮肤的乳腺癌无法显著改善的胸骨转移，胸骨切除术是一种有效的手术技术。首例患者在接受II期乳腺癌根治性乳房切除术后44个月被诊断为胸骨转移并侵犯皮肤。第二例患者为IV期乳腺癌，同时伴有胸骨和肺部转移。仅肺部转移通过化疗 - 内分泌治疗成功得到控制，但胸骨转移在根治性乳房切除术后仍进展。两名患者均表现为孤立性骨转移，并接受了全层胸壁切除术。病例1中，胸壁缺损用背阔肌肌皮瓣修复，病例2中用腹直肌修复。胸骨切除术后20个月，首例患者出现锁骨上淋巴结转移，遂进行包括放疗在内的多学科治疗。该治疗方法有效，患者在胸骨切除术后存活了63个月。第二例患者通过化疗 - 内分泌治疗维持完全缓解状态已达6个月，病情进展良好。这些发现表明，手术切除是治疗孤立性胸骨转移的一种有效局部治疗方法。
