| Objective:Preoperative chemotherapy of breast cancer, also known as neoadjuvant chemotherapy, induction chemotherapy or initial chemotherapy. The earliest applies only to inoperable locally advanced breast cancer, for surgery purposes when tumor becomes smaller. Widely used in patients not breast-conserving surgery for locally advanced breast cancer and breast-conserving will reduce the staging of breast cancer patients, thereby improving the surgical resection rate and the rate of breast conserving; but also as a body susceptibility testing, in order to further understand the sensitivity of tumor cells to chemotherapeutic agents, can not only timely to evaluate the efficacy, adjust the treatment plan, but also can provide a strong basis for the formulation of postoperative chemotherapy; clinical also found that preoperative chemotherapy reached pathological complete remission its long-term survival will be improved.The anthracycline drug is the cornerstone of breast cancer in combination with chemotherapy, preoperative chemotherapy regimens currently used in the vast majority of containing anthracyclines. Taxanes are increasingly widespread application in the clinical treatment of breast cancer preoperative chemotherapy has opened a new chapter, especially in patients with poor response to anthracycline therapy, the more obvious advantages of its efficacy. The anthracycline combination with paclitaxel drug treatment of metastatic breast cancer chemotherapy, applied to preoperative chemotherapy efficacy and toxicity, currently less relevant clinical data, and there is some controversy. In this study, by the application of ET chemotherapy observe the breast cancer preoperative chemotherapy efficacy and safety, and to provide a reference for the choice of chemotherapy in breast cancer before surgery. Methods:The cases of the Fourth Hospital of Hebei Medical University Breast Center admitted â…¡B-â…¢ period from January2010to November2012need to preoperative chemotherapy in patients with primary breast cancer, given the ET regimen (epirubicin75mg/m, dl, d2; injectable paclitaxel175mg/m, d3, every3weeks for1cycle). Two weeks ending evaluate the clinical efficacy of4cycles of chemotherapy effective preoperative evaluation of the effect of chemotherapy and observed side effects after chemotherapy, choose the timing of surgical treatment. After surgery combined with tumor pathological conditions are analyzed.Results:January2010to November2012, a total of43breast cancer patients receiving ET three weeks program preoperative chemotherapy. The initial diagnosis of38cases (88.4%) patients with clinical stage â…¢ breast cancer,34cases (79.1%) patients with preoperative chemotherapy before axillary lymph node (ALN) core needle or fine needle aspiration confirmed metastatic cancers.42cases (97.7%) patients completed the program ET three weeks more than4cycles of preoperative chemotherapy, patients refuse to continue to preoperative chemotherapy after two cycles of chemotherapy, and strongly urge the surgery, carries out a modified radical mastectomy.40cases of patients achieved clinical remission, clinical response rate (complete response CR+partial response PR)93.0%, of which13cases (30.2%) patients achieved a clinical complete response (CCR), of which there are9patients (20.9%) patients achieved pathological complete response (pCR).19cases of preoperative chemotherapy before ALN core needle or fine needle aspiration confirmed patients ALN metastasis cancer metastasis, lymph node negative rate of55.9%(19/34).ER, PR and HER2status, performed a subgroup analysis found that ER-negative (46.5%,20/43) or PR-negative to (60.5%,26/43) of the patients, although the the pCR rates significantly higher than its positive patients(25.0%vs17.4%,30.8%vs5.9%), P=were0.711and0.065, not statistically significant. HER2-positive breast cancer patients,3patients achieved pCR, pCR rate was21.4%(3/14), and HER2-negative breast cancer, the pCR rate was24.0%(6/25), but between, P=1.000, not statistically significant.Integration of ER, PR and HER2status in breast cancer molecular sub-type found11cases LuminalA (HR+/ER2-) two cases of patients achieved pCR patients, pCR rate was18.2%;8cases LuminalB type (HR+/HER2+) patients achieved pCR two cases, the pCR rate was25.0%;4of12cases patients with triple negative (HR-/ER2-) patients achieved pCR,33.3%;1of6cases HER2-positive (HR-/HER2+) patients achieved pCR, accounting for16.7%, among the three groups P=0.910, pCR rate there was no significant difference.3-4degree adverse hematologic adverse reactions, a total of8patients (18.6%) patients, respectively, in1case (2.3%),2cases (4.7%) patients3and4degrees of leukopenia6cases (14%), respectively, in2cases (4.7%) patients with3degrees,4degrees neutropenia. Non-hematologic adverse reactions, mainly gastrointestinal reactions, and hair loss,3degrees of adverse reactions occurred in16cases (37.2%) patients, no patients with4degrees adverse reaction.16cases (37.2%) patients with3degrees of hair loss, and5cases (11.6%) patients with3degrees of nausea, vomiting, and another three cases (7.0%) in patients with diarrhea, three cases (7.0%) of the patients occurred3degrees of oral mucosal injury2degrees of peripheral nerve toxicity in3Li (7.0%) patients, and2degrees of pain in3cases (7.0%) patients, no symptoms of cardiac adverse events in the1cases patients.Conclusion:The combination preoperative chemotherapy with pharmorubicin and paclitaxel is an effective method to treat breast cancer and the toxicities are tolerable.The adverse reactions mainly in the suppression of white blood cells and neutrophils and gastrointestinal reactions. |
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