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目的探讨可手术乳腺癌新辅助化疗(NCT)后的疗效及原发肿瘤缩小后保乳手术的可行性。方法自2001年7月至2003年4月用表阿霉素60mg/m2,d1静注,紫杉醇150mg/m2,d2持续3h静滴,作为NCT方案治疗ⅡB和ⅢA期乳腺癌30例,21d为1个周期,术前共用3～4周期。化疗后肿瘤缩小至3cm以下者行保乳手术或改良根治术,无效者行改良根治术。结果乳腺癌原发肿瘤总有效率(ORR)为93%(28/30),15(50%)例临床完全缓解(cCR),7(23%)例病理完全缓解(pCR),13(43%)例临床部分缓解(cPR),2(7%)例无变化(nochange,NC),无进展病例。26(87%)例临床TNM分期达到了降期目的,NCT前原发肿瘤中位最大径4cm(范围3～10cm),化疗后中位最大径缩小至0.8cm(范围0～6cm)。30例均接受手术治疗,18(60%)例符合保乳适应症。11(37%)例行保乳手术。结论表阿霉素联合紫杉醇的NCT治疗可手术乳腺癌获得较高疗效,能明显地缩小甚至消灭乳腺癌的原发肿瘤,可以扩大保乳手术的适应证,使相当部分病人获得保乳的机会。
Objective To investigate the curative effect of neoadjuvant chemotherapy (NCT) for operable breast cancer and the feasibility of breast conserving surgery after the shrinkage of the primary tumor. Methods From July 2001 to April 2003, intravenous injection of epirubicin 60 mg / m2, d1, paclitaxel 150 mg / m2 and d2 for 3 h were used as NCT regimen to treat 30 cases of stage IIB and stage IIIA breast cancer. 1 cycle, preoperative sharing of 3 to 4 cycles. Chemotherapy after the tumor was reduced to less than 3cm breast-conserving surgery or modified radical mastectomy, ineffective line modified radical mastectomy. Results The total effective rate (ORR) of primary breast cancer patients was 93% (28/30), 15 (50%) cases were complete clinical cCR, 7 (23%) cases were complete remission (pCR), 13 %) Cases of clinical partial response (cPR), 2 (7%) cases of no change (nochange, NC), no progress cases. The TNM staging reached the descending target in 26 (87%) patients. The median diameter of the primary tumor before NCT was 4cm (range 3 ~ 10cm). The median maximum diameter was reduced to 0.8cm (range 0 ~ 6cm) after chemotherapy. All 30 patients underwent surgery, and 18 (60%) were eligible for breast-conserving therapy. 11 (37%) routine breast-conserving surgery. Conclusion Epirubicin combined with paclitaxel NCT treatment of operable breast cancer to obtain a higher effect, can significantly reduce or even eliminate the primary tumor of breast cancer, breast-conserving surgery can expand the indications, so that a considerable part of the patient access to breast-conserving opportunities .