Clark J, Rosenman J, Cance W, Halle J, Graham M
Department of Radiation Oncology, UNC School of Medicine, University of North Carolina-Chapel Hill, 27599, USA.
Int J Radiat Oncol Biol Phys. 1998 Sep 1;42(2):345-50. doi: 10.1016/s0360-3016(98)00212-0.
Breast-conserving therapy (BCS) has generally been limited to T1 and T2 lesions because it has been thought impossible to achieve good local control with satisfactory cosmesis in patients with more advanced disease. However, many patients with T3 and T4 lesions will exhibit dramatic tumor downstaging with neoadjuvant chemotherapy. It is our hypothesis that for these patients BCS can be performed with good local control and cosmesis.
Between February 1991 and November 1995, 34 patients with T3/T4, N0-N2, M0 breast cancer completed treatment consisting of 90 mg/m2 of doxorubicin every 21 weeks x 4, surgery (a local excision if sufficiently downstaged, or mastectomy if not), high dose cyclophosphamide (CMF) every 2 weeks x 4, and radiation therapy. Radionuclide ventriculograms were performed on all patients pre- and postdoxorubicin, and at 6-12 months post radiation therapy. Patients were evaluated for toxicity, local control, cosmesis, disease-free and overall survival.
Median follow-up is 30 months. 15/34 (44%) patients underwent BCS with only one local-regional failure and actuarial 3-year disease-free and overall survival of 77% and 88%. Cosmetic results were good to excellent in 80% of the patients. Left ventricular ejection fraction, which predictably declined following doxorubicin, did not further decline after radiation therapy.
These results suggest that with this regimen a subset of patients with locally advanced breast cancer can preserve their breast with acceptable cosmesis without compromising local control or survival.
保乳治疗（BCS）一般仅限于T1和T2期病变，因为人们一直认为，对于病情更严重的患者，要在获得满意美容效果的同时实现良好的局部控制是不可能的。然而，许多T3和T4期病变的患者在接受新辅助化疗后会出现显著的肿瘤降期。我们的假设是，对于这些患者，可以进行保乳治疗并获得良好的局部控制和美容效果。
1991年2月至1995年11月期间，34例T3/T4、N0-N2、M0期乳腺癌患者完成了治疗，治疗包括每21周给予90mg/m²阿霉素，共4次；手术（如果肿瘤充分降期则行局部切除，否则行乳房切除术）；每2周给予高剂量环磷酰胺（CMF），共4次；以及放射治疗。所有患者在阿霉素治疗前和治疗后，以及放射治疗后6-12个月进行放射性核素心室造影。对患者进行毒性、局部控制、美容效果、无病生存期和总生存期评估。
中位随访时间为30个月。15/34（44%）例患者接受了保乳治疗，仅1例出现局部区域复发，3年无病生存率和总生存率分别为77%和88%。80%的患者美容效果良好至优秀。阿霉素治疗后左心室射血分数可预测地下降，但放射治疗后未进一步下降。
这些结果表明，采用该治疗方案，一部分局部晚期乳腺癌患者可以在不影响局部控制或生存的情况下，保留乳房并获得可接受的美容效果。
