| Breast cancer is one of the most common malignant tumors for women, there are more than 1300,000 new cases of breast cancer worldwide every year. Although its incidence is low in our country, but continues to rise for the past few years, occupying the first place in many cities with the characteristics of younger and locally advanced breast cancer. Surgical treatment is a major means in combined modality therapy for operable breast cancer. Chemotherapy is one of the most important modality and eliminate micrometastases tumor. Neoadjuvant chemotherapy which is referred to preoperative, primary or induction chemotherapy of cancer given before local treatment, such as surgery or radiation, has become the standard of care in the management of patients with locally advanced breast cancer (LABC), and is currently one studyfocus for treatment in patients with operable breast cancers.Neoadjuvant chemotherapy can reduce the size of most primary tumors and have a positive affection on surgery type, but chemotherapeutant has many adverse effects. Overfull preoperative chemotherapy may increase the risk and complications of surgical treatment. Thus, we ought to well define how to operate the neoadjuvant chemotherapy correctly, how many cycles of neoadjuvant chemotherapy is reasonable and coordinate the relationship of the neoadjuvant chemotherapy and surgery. In our study, operable breast cancer with stage lib, Ilia and Illb were treated with neoadjuvant chemotherapy, and investigate the efficacy and rationality of neoadjuvant chemotherapy in operable breast cancer patients.Materials and methods1. Between January 2001 and January 2004, 526 women with clinical stage lib, Ilia and Illb operable breast cancer were treated in department of breast at Henan Tumor hospital. The mean age was 45 years (range, 23 to 84 years). 216 patients were enrolled onto the study, 95 patients were lib and 110 were Ilia, 14 were Illb. All patients were randomized to preoperative group and control group, to ensure that the two groups were similar. Study design and selection of patients : (1) age 65 years, clinical tumor size>2cm with positive axillary nodes or clinical tumor size>5.0cm ; (2) Tumor extension to chest wall or chest muscle byultrasonography were excluded; (3) Pretreatment evaluation included physical examination, blood count and serum chemistry, electrocardiogram, chest X-ray, abdominal ultrasonography and ECT bone scan, patients with distant metastases were excluded; (4) All patients with breast cancer were diagnosed by core needle biopsy, and metastatic involvement of axillary nodes were performed by fine-needle aspiration; (5) Patients receive no therapy before.2. 107 Patients in neoadjuvant group were treated with three cycles of FEC, at intervals of 21 days: 5-fluorouracil -600mg/m intravenously as a 6- 8-hours infusion on day 1 and day 8; epirubicin-75 mg/m, intravenously on day 1; cyclophosphamide-600mg/m, intravenously on day 1 and day 8. Surgical therapy followed within two weeks of the third course of chemotherapy. In control group 112 patients were performed operation after regular examination excluding surgical contraindication. Before surgery patients were assessed with clinical stage, tumor size and location, axillary lymph nodal status, and then were advised to undergo breast conservation surgery, modified radical mastectomy or radical mastectomy. The two largest perpendicular diameters of primary breast tumors were measured by physical examination and ultrasonography before and after the administration of neoadjuvant chemotherapy. To have been considered assessable for tumor response, every patient must be assessed by two doctors respectively, and had bidimensionalmeasurements recorded after the end of every cycle. Before neoadjuvant chemotherapy or surgery all patients evaluated by routinely examination, such as physical examination, a complete blood cell count with differential count, hepatic and renal function, electrocardiogram, chest X-ray, abdomen ultrasonography, bone-scanning. Clinical response...
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