Long-term outcome of neoadjuvant therapy for locally advanced breast carcinoma - Effective clinical downstaging allows breast preservation and predicts outstanding local control and survival
Long-term outcome of neoadjuvant therapy for locally advanced breast carcinoma - Effective clinical downstaging allows breast preservation and predicts outstanding local control and survival
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DOI：
10.1097/00000658-200209000-00006
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发表时间：
2002-09-01
影响因子：
9
通讯作者：
Graham, M
中科院分区：
文献类型：
--
作者：
Cance, WG;Carey, LA;Graham, M
目的总结62例局部晚期乳腺癌（LABC）采用统一的综合治疗方案的长期随访资料。作者确定了乳腺保留率，无病生存率和总生存率，以及与局部和远处复发diseases.Summary背景数据相关的因素，实现LABC的局部和远处控制仍然是一个挑战。在过去的十年中，术前或新辅助化疗已成为这些患者的标准治疗。成功的肿瘤降级与保乳治疗（BCT）的增加率有关，但对长期生存的总体影响仍有待观察。方法本研究探讨了一个队列的62例LABC患者在作者的机构从1992年至1998年。统一的治疗方案包括新辅助阿霉素（阿霉素），然后是手术（BCT，如果足够的临床降级），然后是非交叉耐药环磷酰胺/甲氨蝶呤/5-氟尿嘧啶，然后是放射治疗。治疗是剂量密集型和时间密集型，总治疗时间为32至35 weeks.Results在这个患者人群中，中位年龄为44岁，约三分之二的白色患者和三分之一的非洲裔美国人。82%的患者在就诊时为临床III期，13例患者患有T4 d炎性癌症，3例患者在诊断时为IV期。84%的患者表现出对阿霉素的显著临床反应。28例患者有足够的临床降级尝试BCT，49例非炎症患者中有22例（45%）成功进行了BCT。15%的患者病理学完全缓解。该队列的中位随访时间为70个月。局部复发率为14%，其中BCT患者中有2例同侧乳腺肿瘤复发（10%）。7例（12%）患者在对侧乳腺发生了新的原发性癌症。18例（31%）患者发生远处转移，队列的5年总生存率为76%。此外，在接受尝试BCT的患者中，5 years.Conclusions剂量密集型和时间密集型多模式新辅助治疗的生存率为96%，在缩短的时间内成功地管理到一个混合种族组。具有足够的临床降级以允许BCT的患者具有最佳的长期结局。需要乳房切除术的患者复发的风险更高，以及新的对侧癌症的发展，但5年生存率超过50%。
Objective To review the long-term follow-up data from the authors' institutional experience of 62 patients with locally advanced breast cancer (LABC) treated with a uniform multimodality regimen. The authors determined the rate of breast preservation, the disease-free and overall survival, and the factors associated with locoregional and distant recurrent disease.Summary Background Data It remains a challenge to achieve local and distant control of LABC. Over the last decade, preoperative or neoadjuvant chemotherapy has emerged as the standard of care for these patients. Successful tumor downstaging has been associated with increased rates of breast-conserving therapy (BCT), but the overall effect on long-term survival remains to be seen.Methods This study examines a cohort of 62 patients with LABC treated at the authors' institution from 1992 to 1998. The uniform treatment regimen consisted of neoadjuvant doxorubicin (Adriamycin), followed by operation (BCT if sufficient clinical downstaging), followed by non-cross-resistant cyclophosphamide/methotrexate/5-fluorouracil, followed by radiation therapy. Treatment was both dose-intensive and time-intensive, with a total treatment time of 32 to 35 weeks.Results In this patient population, the median age was 44 years, with approximately two thirds white patients and one third African American. Eighty-two percent of patients were clinical stage III at presentation, 13 patients had T4d inflammatory cancers, and 3 patients were stage IV at diagnosis. Eighty-four percent of patients demonstrated a significant clinical response to doxorubicin. Twenty-eight patients had sufficient clinical downstaging to attempt BCT, and 22 (45%) of 49 noninflammatory patients underwent successful BCT. Pathologic complete response was seen in 15% of patients. Median follow-up for the cohort was 70 months. The local recurrence rate was 14%, including two ipsilateral breast tumor recurrences (10%) in the BCT patients. Seven (12%) patients developed a new primary cancer in the contralateral breast. Distant metastases occurred in 18 (31%) patients, and the 5-year overall survival rate for the cohort was 76%. Furthermore, in the patients who underwent an attempt at BCT, the survival rate was 96% at 5 years.Conclusions Dose-intensive and time-intensive multimodality neoadjuvant therapy was successfully administered to a mixed racial group over shortened times. Patients who had sufficient clinical downstaging to allow BCT have the best long-term outcome. Patients who required mastectomy are at a higher risk of relapse, as well as the development of new contralateral cancers, yet have 5-year survival rates of over 50%.