立体超选择性动脉灌注化疗在乳腺癌降期保乳术中价值.docVIP

立体超选择性动脉灌注化疗在乳腺癌降期保乳术中价值 　作者:何劲松，王先明，佟建蒙，朱国献，伍建春，李 戎，刘琨，郭良峰，周汝明，邱水波，关弘 【摘要】 目的 评价术前立体超选择动脉灌注化疗在Ⅰ、Ⅱ期乳腺癌保留乳房手术(BCT)中的价值。方法 术前采用立体超选择动脉灌注丝裂霉素(MMC) 8～12mg/m2、表阿霉素(EADR) 60～80mg/m2和5-氟脲嘧啶(5-Fu)750～1000mg/m2，共治疗36例乳腺癌，其中Ⅰ期10例，Ⅱ期26例。化疗后再进行手术。结果 灌注化疗后CR+PR 32例，MR 3例，1例无明显变化，缓解率达89%。Ⅱ期患者中有22例肿瘤直径缩小到2cm以下，获得BCT手术机会。结论 术前立体超选择性动脉灌注化疗可使Ⅱ期乳腺癌降期获得BCT手术机会。 【关键词】 乳腺癌；立体超选择性动脉灌注化疗；保留乳房手术 Importance of preoperational stereotactic superselective intraarterial chemotherapy in lowering stage for breast carcinoma conservative surgical treatment(BCT) of breast cancer 【Abstract】 Objective To evaluate the importance of preoperational stereotactic superselective intraarterial chemotherapy in breast carcinoma conservative surgical treatment(BCT) for phase Ⅰ、Ⅱ breast cancer . Methods To treat thirty-six cases of breast cancer patients(including phase Ⅰ 10 cases，phase Ⅱ 26 cases) by infusing MMC8～12mg/m2，EADR60～80mg/m2，5-Fu750～1000mg/m2 via preoperational stereotactic superselective intraarterial chemotherapy.After chemotherapy，operation was adopted.Results CR+PR 32 cases，MR 3 cases and 1 cases had no marked change after chemotherapy，and the improved rate of the focus was 89%.In 22 cases of phase Ⅱ，the diameter of tumor shrunk to be smaller than 2 cm and therefore were given BCT.Conclusion It is possible to lower stage and gain the chance of BCT for phase Ⅱ breast cancer patients by methods of preoperational stereotactic superselective intraarterial chemotherapy. 【Key words】 breast cancer；stereotactic superselective intraarterial chemotherapy；breast carcinoma conservative surgical treatment 近年来，乳腺癌保留乳房手术越来越受到重视，如何把握保乳指征，创造保乳机会成为研究的热点。2002年6月～2004年7月笔者采用术前立体超选择性动脉灌注化疗治疗乳腺癌36例，对化疗后肿瘤直径小于2cm的患者，采用保留乳房的乳癌根治术（breast carcinoma conservative surgical treatment，BCT），效果良好。 1 资料与方法 1.1 一般资料 36例均为女性乳腺癌患者，年龄24～58岁，平均41岁；其中右乳为右侧20例，左乳16例；肿瘤均位于外上象限21例，外下10例，内上5例；均为单发病灶，原发病灶≤2cm 14例，2～5cm 22例，其边缘距乳晕≥3cm；按国际抗癌联盟(UICC)制定的TNM分期标准Ⅰ期10例，Ⅱ期26例；治疗前均经病理确诊，病理分型：浸润性导管癌10例，单纯癌18例，腺癌6例，髓样癌2例；腋淋巴结转移4例；36