HIGH COMPLETE REMISSION RATES WITH PRIMARY NEOADJUVANT INFUSIONAL CHEMOTHERAPY FOR LARGE EARLY BREAST-CANCER
HIGH COMPLETE REMISSION RATES WITH PRIMARY NEOADJUVANT INFUSIONAL CHEMOTHERAPY FOR LARGE EARLY BREAST-CANCER
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DOI：
10.1200/jco.1995.13.2.424
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发表时间：
1995-02-01
影响因子：
45.3
通讯作者：
BAUM, M
中科院分区：
文献类型：
--
作者：
SMITH, IE;WALSH, G;BAUM, M
目的：探讨氟尿嘧啶（5 FU）持续输注联合表阿霉素和顺铂（ECF）每3周1次作为原发性化疗替代立即乳房切除术治疗大的、有手术可能的乳腺癌患者的疗效。50例可手术切除的大型乳腺癌患者，肿瘤直径6 cm（范围3 ~ 12）例患者，均给予5 FU 200 mg/m2/d，经Hickman静脉输注，使用流动泵，持续6个月，其中表阿霉素50 mg/m2静脉输注，顺铂60 mg/m2静脉输注，每3周1次，共8个疗程。随后的手术和/或放疗是由临床respons.Results：49例患者达到了总体反应（98%; 95%置信区间[CI]，94%至100%），包括33个完全临床缓解（CR）（66%; 95% CI，53%至79%）。只有3名患者（6%）仍然需要乳房切除术。治疗3周后，81%的患者在重复穿刺活检时肿瘤细胞明显减少，而常规化疗后的类似患者仅为36%（P <0.002）。严重的（世界卫生组织[WHO] 3至4级）毒性是罕见的，恶心/呕吐是最常见的，发生在20%的patients.Conclusion：原发性输注ECF似乎是更积极的临床和组织病理学的理由比传统的化疗大型可操作的乳腺癌，耐受性良好。这种方法现在值得进行随机比较，以确定高CR率是否可以转化为生存率的改善。
Purpose: To investigate the efficacy of continuous infusion fluorouracil (5FU) with every-3-week epirubicin and cisplatin (ECF) as primary chemotherapy instead of immediate mastectomy for patients with large, potentially operable, breast cancer.Patients and Methods: Fifty patients with large operable breast cancer, tumor diameter 6 cm (range, 3 to 12), were treated with 5FU 200 mg/m(2)/d via a Hickman line using an ambulatory pump for 6 months with epirubicin 50 mg/m(2) intravenously (IV) and cisplatin 60 mg/m(2) IV every 3 weeks for eight courses. Subsequent surgery and/or radiotherapy was determined by clinical response.Results: Forty-nine patients achieved an overall response (98%; 95% confidence interval [CI], 94% to 100%), including 33 complete clinical remissions (CRs) (66%; 95% CI, 53% to 79%). Only three patients (6%) still required mastectomy. Tumor cellularity was markedly reduced on repeat needle biopsy following 3 weeks of treatment in 81% of patients versus only 36% in similar patients after conventional chemotherapy (P < .002). Severe (World Health Organization [WHO] grade 3 to 4) toxicity was rare, with nausea/vomiting being the most common, occurring in 20% of patients.Conclusion: Primary infusional ECF appears to be more active on clinical and histopathologic grounds than conventional chemotherapy for large operable breast cancer and is well tolerated. This approach now merits randomized comparison to determine if high CR rates may translate into improved survival.