三阴乳腺癌术后辅以密集化疗的临床疗效

摘要

Objective:To evaluate the clinical efficacy of dose - dense chemotherapy in the postoperative treatment of triple - negative breast cancer. Methods:All 43 patients were enrolled. The patients were divided into two groups at random. The dose - dense group was treated with THP 50mg/ m2 ,d1 ,TAX 175mg/ m2 ,d2 ,repeated every 14 days. The conventional group was treated with THP 50mg/ m2 ,d1 ,TAX 175mg/ m2 ,d2 ,repeated every 21 days. Both with a total treatment of 6 cycles. All patients accepted breast and supraclavicular radiotherapy reach to DT = 50Gy/(25f·5w) after 6 cycles of chemotherapy. Results:All 43 patients completed treatment as planned. All patients were followed -up for more than 60 months,with a follow - up rate 97. 7% . The three years disease free survival rate was 60. 9% and 30. 0%(P < 0. 05)in dose - dense group and conventional group. The three years total survival rates were 78. 0% and 65. 0%(P > 0. 05). The five years disease free survival rate was 13. 0% and 10. 0%(P > 0. 05)in dose - dense group and conventional group. The five years total survival rate was 39. 0% and 30. 0%(P > 0. 05)in two groups. But the DFS of the dose - dense group was longer than the conventional group. The adverse effect of gastrointestine, arrest of marrow and cardiac toxicity was no significant difference between dose - dense group(47. 8% ,65. 2% , 47. 8% )and conventional group(45. 0% ,55. 0% ,40. 0% ). There was no Ⅲ° - Ⅳ° adverse effect of gastrointestine and cardiac toxicity in all patients. Conclusion:The dose - dense chemotherapy in the postoperative treatment of triple- negative breast cancer can prolong the MDFS and effectively improve the three years disease free survival rate,with tolerable toxicity.%目的：探讨三阴乳腺癌术后辅以剂量密集化疗的临床疗效。方法：选取2004年6月至2010年1月43例三阴乳腺癌患者随机分为治疗组（密集化疗组）和对照组（常规化疗组）。两组患者均采用盐酸吡柔比星（THP）50mg/ m2，d1，紫杉醇（TAX）175mg/ m2，d2。密集化疗组每14d 重复，而对照组每21d 重复。共6个周期。两组患者化疗结束后均给予患侧胸壁及同侧锁骨上放疗 DT 总=50Gy/（25f·5w）。结果：全部病例均按计划完成治疗，并随访60个月以上，随访率97.7%。密集化疗组与常规治疗组的3年无病生存率分别为60.9%和30.0%（P <0.05）。两组3年总生存率分别为78.0%和65.0%（P >0.05）。密集化疗组和常规化疗组的5年无病生存率及5年总生存率分别为13.0%、10.0%（P >0.05）和39.1%、30.0%（P >0.05）。但密集化疗组的无病生存期（DFS）为11~28个月，中位无病生存期（MDFS）为23.4个月，较常规化疗组无病生存期（10~25个月）及中位无病生存期（20.6个月）明显延长。两组在胃肠道反应、骨髓抑制及心脏毒性等毒副反应方面的发生率分别为47.8%、65.2%、47.8%和45.0%、55.0%、40.0%，均无显著性差异（P >0.05）。两组均无Ⅲ-Ⅳ度胃肠道反应及心脏毒性。结论：三阴乳腺癌术后辅以密集化疗能有效提高患者3年无病生存率，延长患者无病生存期，且相关毒副反应未明显增加。