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目的探讨以蒽环类药物吡柔比星(THP)为主的联合新辅助化疗对III期原发性乳腺癌新辅助化疗的近期临床效果。方法对1 3 8例手术前确诊的III期原发性乳腺癌采用以吡柔比星为主的CTF方案化疗1~4个周期,观察临床疗效、保乳手术率和毒副反应。结果全组总有效率为7 5.4%(1 0 4/1 3 8);其中完全病理缓解1例,临床完全缓解1例(0.7%),部分缓解1 0 2例(73.9%),无变化3 2例(2 3.2%),进展2例(1.4%)。实施保乳手术7例(5.1%)。施行化疗3+4周期的疗效和保乳手术率均明显高于1+2周期者(均P<0.0 5)。该方案的脱发反应轻,I度脱发2 8例(2 0.3%);心脏毒性较小,室性期外收缩发生率1.4%(2/1 3 8),无充血性心衰病例。但骨髓抑制较明显,总发生率5 5.8%(7 7/1 3 8),其中II度骨髓抑制发生率为2 7.5%(3 8/1 3 8),III度骨髓抑制发生率为2 1.0%(2 9/1 3 8),IV度骨髓抑制发生率为7.2%(1 0/1 3 8)。结论以吡柔比星为主的CTF方案用于乳腺癌新辅助化疗心脏毒性小,近期疗效较满意;但骨髓抑制发生率高,治疗期间应予支持治疗。
Objective To investigate the short-term clinical effect of neoadjuvant chemotherapy combined with pirarubicin (THP), an anthracycline, on neoadjuvant chemotherapy for stage III primary breast cancer. Methods A total of 138 cases of preoperatively diagnosed stage III primary breast cancer were treated with 1 to 4 cycles of chemotherapy with pirarubicin-based CTF. Clinical efficacy, the rate of breast-conserving surgery and toxicity were observed. Results The total effective rate of the whole group was 74.4% (104 cases). Among them, complete pathological remission was found in 1 case, clinical complete remission in 1 case (0.7%) and partial remission in 102 cases (73.9%), with no change 32 cases (22.2%), 2 cases (1.4%). 7 cases of breast conserving surgery (5.1%). The effect of 3 + 4 cycles of chemotherapy and the rate of breast conserving surgery were significantly higher than that of 1 + 2 cycles (all P <0.0 5). The regimen of alopecia was light, with 18 cases (23.3%) of I degree alopecia; small cardiotoxicity and 1.4% (2/1 38) cases of ventricular extrasystole without congestive heart failure. However, myelosuppression was more obvious with a total incidence rate of 5.8% (7 7/1 3 8). The incidence of myelosuppression in grade II was 21.5% (38/1 38), and the incidence of myelosuppression in grade III was 2 1.0 % (2 9/1 3 8), the incidence of IV degree myelosuppression was 7.2% (10/1 3 8). Conclusions The pirarubicin-based CTF regimen is less toxic to neoadjuvant chemotherapy for breast cancer and has satisfactory short-term curative effect. However, the high incidence of myelosuppression should be supported during the treatment.