Conservation treatment intensified with tamoxifen and CAF chemotherapy without axillary dissection for early breast cancer patients with clinically-negative axillary nodes.
Conservation treatment intensified with tamoxifen and CAF chemotherapy without axillary dissection for early breast cancer patients with clinically-negative axillary nodes.
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对于临床阴性腋窝淋巴结的早期乳腺癌患者，采用他莫昔芬和 CAF 化疗加强保守治疗，不进行腋窝淋巴结清扫。
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
N. Tohchika
中科院分区：
文献类型：
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作者：
Y. Ogawa;A. Nishioka;T. Inomata;N. Yokota;T. Sasaki;M. Terashima;S. Yoshida;Y. Tanaka;N. Tohchika
100多年来，腋窝淋巴结清扫一直是乳腺癌治疗的常规部分。由于很少有患者有阳性结节，应该更多地考虑取消对导管原位癌(DCIS)和T1a病变的腋窝淋巴结清扫。对于T1/2N0M0的乳腺癌患者，单纯切除肿块而不进行腋窝清扫，然后对完整的乳房和区域淋巴结进行放射治疗，应是避免上肢并发症的合理治疗方法。从1989年9月至1998年12月，我们用这种方法治疗79例乳腺癌患者，加强他莫昔芬和CAF化疗。在治疗开始前，我们使用螺旋CT和多普勒超声进行了彻底的评估，以排除腋窝淋巴结显著肿大(短径>5 mm)的患者。截至1998年12月底，平均随访期为52.6个月。到目前为止，79名患者中只有一名患者在治疗开始后5年内出现局部复发。这位病人接受了第二次肿瘤切除术。6个月后，她经历了肺转移。她目前正在接受多西紫杉醇和顺铂的联合化疗。本组79例患者术后6年的病因生存率为100%，无腋窝衰竭发生。在截至1998年12月底在世的76例患者中，50例(65.8%)的美容效果为优，26例(34.2%)为良，没有一例为可或差。因此，我们得出结论，这种治疗早期乳腺癌的方法可以消除手术损伤，并获得良好的美容效果，而且这种治疗的存活率很高。
Axillary node dissection has been a routine part of breast cancer treatment for more than 100 years. As so few patients have been shown to have positive nodes, more consideration should be given to eliminating axillary node dissection for duct carcinoma in situ (DCIS) and T1a lesions. And for patients with a T1/2N0M0 cancer of the breast, lumpectomy alone without axillary dissection followed by radiation therapy to the intact breast and regional lymph nodes should be a reasonable treatment method that avoids arm morbidity. Between September 1989 and December 1998, we treated 79 breast cancer patients with this method intensified with tamoxifen and CAF chemotherapy. Before the start of the therapy, we performed a thorough evaluation using helical CT and doppler ultrasonography to exclude patients with significant swelling of axillary lymph nodes (more than 5 mm in short diameter). Through the end of December 1998, the mean follow-up period was 52.6 months. Up to this date, only one patient of the 79 showed local recurrence within 5 years after the start of the treatment. This patient received a second lumpectomy. She then experienced lung metastases 6 months later. She is currently receiving combined chemotherapy with docetaxel and cisplatin. The cause-specific survival rate of these 79 patients maintained 100% at 6 years, and no axillary failure has been experienced so far. The cosmetic results in 50 (65.8%) of the 76 patients who were alive at the end of December 1998 were rated as excellent, 26 (34.2%) as good, and none as fair or poor. Therefore, we have concluded that this method of treatment for early breast cancer could eliminate surgical damage and allow good cosmetic results, and that survival rates with this treatment are excellent.