Ogawa Y, Nishioka A, Inomata T, Tsuboi N, Hayase N, Fukumoto M, Yoshida S, Tohchika N, Tanaka Y, Kumon M
Department of Radiology, Kochi Medical School, Oko-cho, Nankoku-shi, Kochi-Prefecture 783-8505, Japan.
Oncol Rep. 1998 Nov-Dec;5(6):1337-41. doi: 10.3892/or.5.6.1337.
Formerly, patients with subareolar breast cancers have not been good candidates for breast-conservation treatment (BCT) in Japan. However, recently it was reported that patients with subareolar cancers were good candidates for this treatment. In order to improve both cosmetic results and survival rates, we performed BCT for 27 patients with subareolar breast cancers following pre-operative CAF chemotherapy and tamoxifen administration. From August 1989 to June 1998, we performed BCT for 200 out of 206 patients who visited our hospital with the desire of breast-conservation. Of these patients, 27 presented with tumors within 2 cm of the nipple areolar complex. For 26 of these 27 patients, breast-conserving surgery was performed following two to four times of CAF chemotherapy, and another one patient did not undertake any surgical resection. Following the surgery, patients were treated with radiation therapy to the intact breast and ipsilateral axilla to a total dose of 4,400 cGy with electron conedown to a total dose of 5,300 cGy. Their primary tumors were at T4bN0 in 1 case, T2N1b in 5 cases, T2N0 in 18 cases, and T1cN0 in 3 cases. Tamoxifen was administered to all the patients. CAF chemotherapy was performed six times for stage I patients, and eight times for stage II patients in total. For one patient with direct tumor invasion to the nipple, intraarterial infusion chemotherapy was performed following radiation therapy and CAF chemotherapy, without any surgical resection. For another 26 patients, breast-conserving surgery was performed, and 5 of them underwent lumpectomy under local anesthesia on an outpatient basis. For these 26 patients, the microscopic surgical margin was positive for 8 patients, close for 6 patients, negative for 10 patients, and unknown for 2 patients. All patients are alive with no evidence of disease after a follow-up of approximately 47 months on average, and all of their cosmetic results are estimated as excellent or good. It is concluded that BCT intensified with preoperative CAF chemotherapy and tamoxifen for subareolar breast cancers is a satisfying treatment modality in terms of both cosmetic results and survival rates.
以前，在日本，乳晕下乳腺癌患者并非保乳治疗（BCT）的理想人选。然而，最近有报道称乳晕下癌症患者是这种治疗的理想人选。为了提高美容效果和生存率，我们对27例乳晕下乳腺癌患者在术前进行CAF化疗并给予他莫昔芬后实施了保乳治疗。从1989年8月至1998年6月，我们对206例因希望保乳而来我院就诊的患者中的200例实施了保乳治疗。在这些患者中，27例肿瘤位于乳头乳晕复合体2厘米范围内。这27例患者中有26例在接受两到四次CAF化疗后进行了保乳手术，另1例患者未进行任何手术切除。手术后，对完整乳房和同侧腋窝进行放射治疗，总剂量为4400厘戈瑞，电子缩野追加剂量至总剂量5300厘戈瑞。其原发肿瘤1例为T4bN0，5例为T2N1b，18例为T2N0，3例为T1cN0。所有患者均接受他莫昔芬治疗。I期患者共进行6次CAF化疗，II期患者共进行8次CAF化疗。1例肿瘤直接侵犯乳头的患者在放疗和CAF化疗后进行了动脉内灌注化疗，未进行任何手术切除。另外26例患者进行了保乳手术，其中5例在门诊局部麻醉下进行了肿块切除术。这26例患者中，8例显微镜下手术切缘阳性，6例切缘接近，10例切缘阴性，2例切缘情况不明。所有患者平均随访约47个月后均存活且无疾病证据，所有患者的美容效果评估为优或良。结论是，对于乳晕下乳腺癌，术前CAF化疗和他莫昔芬强化的保乳治疗在美容效果和生存率方面都是一种令人满意的治疗方式。
