Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.

Objective:To analyze the prognosis of patients with isolated regional recurrence (RR) after mastectomy, and evaluate the efficacy of radiotherapy and identify the optimal radiation target volumes.Methods:Clinical data of 144 patients with first isolated RR after mastectomy between 2001 and 2018 were retrospectively analyzed. All patients had not received post-mastectomy radiotherapy. The primary endpoints consisted of the subsequent locoregional recurrence (sLRR), distant metastasis (DM), progression-free survival (PFS) and overall survival (OS).Results:With a median follow-up of 82.5 months after RR, the 5-year sLRR, DM, PFS and OS rates for the entire group were 42.1%, 71.9%, 22.9% and 62.6%, respectively. Local plus systemic therapy was an independent favorable prognostic factor for sLRR ( P<0.001) and PFS ( P=0.013). The sLRR rate in the surgery plus radiotherapy group was the lowest ( P<0.001). Surgery plus radiotherapy significantly reduced the 5-year risk of recurrence within the initially involved nodal regions ( P<0.001). Patients with chest wall irradiation obtained the 5-year subsequent chest wall recurrence rate of 12.1% compared to 14.8%( P=0.873) for those without chest wall irradiation. The subsequent supraclavicular recurrence rate was lower in patients with prophylactic supraclavicular irradiation than that without prophylactic supraclavicular irradiation (9.9% vs. 23.8%, P=0.206). The incidence rates of initially uninvolved axillary and internal mammary nodal recurrence were below 10% regardless of prophylactic irradiation or not. Conclusions:Patients with RR alone have an optimistic 5-year OS in the contemporary era. Comprehensive locoregional treatment including surgery and radiotherapy combined with systemic therapy is recommended. The chest wall, axillary and internal mammary nodal prophylactic irradiation should not be routinely performed for all patients with RR. The value of supraclavicular prophylactic irradiation remains to be evaluated.

目的 探讨晚期乳腺癌肝转移导致重度肝功能异常后的治疗选择和疗效.方法 回顾性分析2003年至2018年我团队收治的乳腺癌肝转移导致严重肝功能异常患者49例,观察临床疗效和治疗方式的选择.结果 49例患者中28例继续行抗肿瘤治疗,获PR 7例,SD 7例,PD 14例,总有效率(ORR)为25.0％,疾病控制率(DCR)为50.0％.重度肝功能异常后治疗组与未治疗组中位生存期分别为3.0个月和0.5个月(P<0.05).治疗组中初治为单药化疗(或联合靶向治疗)21例,联合化疗3例,3例患者接受内分泌治疗,1例接受曲妥珠单抗单药治疗.在化疗方案中,紫杉类6例,卡培他滨5例,吉西他滨5例,长春瑞滨3例,依托泊苷3例,曲妥珠单抗联合治疗9例,抗血管生成联合治疗5例.结论 乳腺癌肝转移导致重度肝功能异常的患者如果前期治疗不充分继续行解救治疗仍然可能有效,但是建议首选有效率高、肝毒性小的药物,且采取初始药物剂量酌情下调等个体化给药模式.

Objective:To explore the dosimetric characteristics of whole brain radiotherapy (WBRT) and CyberKnife stereotactic radiotherapy (SRT) in breast cancer patients with 4-9 brain metastases.Methods:The clinical and imaging data of 10 breast cancer patients with 4-9 brain metastases in the Fifth Medical Centre, Chinese PLA General Hospital between March 2015 and November 2015 were retrospectively analyzed. CT and magnetic resonance imaging (MRI) images were imported into the treatment planning system to achieve the fused images for delineating. A radiotherapy treatment plan was designed after delineating the target area. WBRT was administered with two fields, and the prescription dose was 30 Gy in 10 fractions. SRT was administered by the CyberKnife with the prescription dose of 16-18 Gy in one fraction. The volume and dose of the tumor target area, optic nerve, optic chiasm, brain stem, hippocampus and other critical organs were calculated; and radiotherapy dose indexes of WBRT and SRT were compared after conversion to a biological effective dose (BED).Results:The maximum dose (BED 4) in the SRT group was higher than that in the WBRT group [(191.0±41.3) Gy vs. (52.5±0.0) Gy, t = 10.596, P < 0.01]. The brain tissue and tumor in the target area of WBRT received the same uniform dose of 120.0 Gy. The median maximum dose of BED 1 of partial organs at risk in the SRT group was lower than that in the WBRT group [(left optic nerve: 3.9 Gy (0.1-11.2 Gy), right optic nerve: 3.9 Gy (0.2-8.9 Gy), optic chiasm: 5.1 Gy (3.8-19.4 Gy); all P < 0.05]. The median volume dose of BED 1 in the SRT group were lower than that in the WBRT group (brain stem V 1/3: 4.5 Gy (1.9-5.7 Gy), normal brain tissue V 2/3: 3.1 Gy (1.3-4.3 Gy), left optic nerve 0.2 cm 3: 2.7 Gy (0.0-8.8 Gy), right optic nerve 0.2 cm 3: 3.0 Gy (0.0-6.7 Gy), optic chiasm 0.2 cm 3: 3.6 Gy (2.5-14.8 Gy), left hippocampus V 1/3: 5.4 Gy (2.1-10.4 Gy), right hippocampus V 1/3: 4.6 Gy(2.4-12.5 Gy); all P < 0.05). Conclusion:The dosimetric simulation results show that SRT for breast cancer patients with 4-9 brain metastases result in a significantly higher dose of the tumor target area and a significantly lower dose of some organs at risk compared with WBRT; and organs at risk meet the requirement of the dose constraints.

目的:比较左侧乳腺癌保乳术后自由呼吸、吸气末屏气两种呼吸模式下放射治疗计划的靶区、心脏、冠状动脉左前降支、左肺以及右侧乳腺等危及器官的剂量参数,探索在左侧乳腺癌保乳放疗中能最大程度减少靶区周围重要组织器官受照体积和剂量的呼吸模式.方法:选取左侧乳腺癌保乳术后的患者10例,年龄38 ～ 65岁,采用乳腺托架进行体位固定.用Philips Brilliance 16排大孔径CT定位机进行图像扫描,扫描层厚3 mm,分别采集自由呼吸(free breath,FB)、吸气末屏气(inspiration breath hold,IBH)两种呼吸模式下的CT图像.将CT图像传输到Varian Eclipse治疗计划系统进行图像重建,勾画靶区及危及器官,分别设计两种呼吸模式下的6野调强计划,比较两种呼吸模式下的靶区和危及器官剂量学参数.结果:FB、IBH两种呼吸模式下,靶区的最大剂量、平均剂量、均匀指数及体积差异均无统计学意义(P＞0.05).FB、IBH两种呼吸模式下危及器官受量对于心脏:D max分别为(46.61±1.68) Gy、(39.29±8.40) Gy,Dmean分别为(6.74±4.00)Gy、(5.39 ±4.12)Gy,差异均有统计学意义(P＜0.05);V5、V10、V20、V30的差异也均有统计学意义(P＜0.05).冠状动脉左前降支(LAD):Dmax分别为(39.64 ±4.31)Gy、(30.54 ±9.08) Gy,Dmean分别为(31.21 ±7.70) Gy、(22.72 ±9.36) Gy,差异均有统计学意义(P＜0.05).左肺:Dmean分别为(9.11 ±2.61) Gy、(8.74 ±2.01)Gy,差异无统计学意义(P＞0.05);V5、V10、V20、V30的差异也均无统计学意义(P＞0.05).右侧乳腺:Dmax分别为(4.76±1.94) Gy、(5.06 ±2.15)Gy,Dmean分别为(1.32±1.01)Gy、(1.30 ±0.94) Gy,差异均无统计学意义(P＞0.05).结论:左侧乳腺癌保乳术后两种呼吸模式计划比较,靶区受照剂量、左肺受照剂量及右侧乳腺受照剂量均无明显差异.吸气末屏气技术明显降低了心脏、LAD的受照剂量.

目的 贝伐珠单抗是首个抗血管生成的分子靶向药物,可以与多种化疗药物联合用于治疗复发转移性乳腺癌.本研究旨在观察多西他赛联合贝伐珠单抗多线解救治疗晚期复发转移性乳腺癌的疗效和不良反应.方法 回顾性分析2008-05-01-2018-05-01解放军307医院肿瘤中心放疗科收治的接受多西他赛联合贝伐珠单抗多线治疗复发转移性乳腺癌患者27例,观察临床疗效,记录不良反应,计算无进展生存期.结果 27例患者均可评价疗效和不良反应,其中部分缓解11例,疾病稳定15例,客观有效率为40.7％,疾病控制率为96.3％,中位无进展生存时间为4个月(95％CI:2.9～5.1个月).其中21例患者既往辅助或解救治疗阶段曾使用过紫杉类药物,再次应用紫杉类联合贝伐珠单抗有效率为38.1％,中位无进展生存时间为4个月(95％CI:3.1～4.9个月).白细胞减少及粒细胞减少是主要不良反应,3～4级白细胞减少发生率为55.6％,其中3例伴粒细胞减少性发热.消化道反应7例、口腔粘膜炎4例、乏力5例、脱发7例,均为1～2级.结论 多西他赛联合贝伐珠单抗治疗多线解救失败的晚期难治性乳腺癌具有一定疗效,在既往应用过紫杉类药物的患者中也有一定疗效,不良反应可耐受,值得临床进一步研究及应用.

Aromatase inhibitors (AIs) directly applies to postmenopausal breast cancer patients. Patients underwent bilateral ovariectomy or ≥60 years were acknowledged as postmenopausal.Alternatively, for <60 years breast cancer patients, sex hormone detection to evaluate menopause is recommended by National Comprehensive Cancer Network (NCCN) guideline, textbooks, and AIs clinical trials.However, series of clinical trial found that, a broad overlap region of follicle stimulating hormone and estradiol appeared between premenopausal and postmenopausal patients, which unable to determine the menopause even with sensitivity promotion of detection equipment or manners.We have abandon this detection in clinical treatment, and decision making was only according to the relapse risk and disease status. We recommend bilateral ovariectomy resection accompanied with AIs for breast cancer patients with high recurrence risk (e.g. T3-4 or LNM≥4) or patients with advanced metastatic disease.However, patients with low or moderate recurrence risk can be treated with tamoxifen.

目的 乳腺癌患者的单纯骨转移发生率较低.本研究旨在探讨影响乳腺癌单纯骨转移患者预后的因素.方法 回顾性分析解放军307临床学院肿瘤中心2012-01-01-2015-12-31收治的96例乳腺癌单纯骨转移患者临床资料,采用Kaplan-Meier法和Cox回归分析,分析影响乳腺癌单纯骨转移患者预后的相关因素.结果 乳腺癌单纯骨转移患者骨转移后中位生存时间为45个月(95 ％CI:29.4～60.6),中位骨外无进展时间为22个月(95％CI:15.6～28.4).单因素分析显示,肿瘤大小、术后腋窝淋巴结转移数目、Ki-67、术后无病生存期(disease-free survival,DFS)、解救放疗、解救内分泌治疗与单纯骨转移患者骨外转移的发生有显著相关性.而肿瘤大小、激素受体状况、骨转移数目、术后DFS、内分泌治疗与单纯骨转移后生存期有显著相关性.通过Cox多因素回归分析发现,Ki-67 (P=0.037)和解救放疗(P=0.029)是乳腺癌单纯骨转移患者发生骨外转移的主要影响因素,骨转移灶数目(P=0.003)和解救内分泌治疗(P=0.017)是影响单纯骨转移患者生存期的主要因素.而激素受体阳性单纯骨转移患者中,术后DFS(P=0.032)、骨转移灶数目(P=0.004)和解救内分泌治疗(P=0.018)是影响患者生存期的主要因素.结论 Ki-67高表达是乳腺癌单纯骨转移患者发生骨外转移的独立危险因素,解救放疗可能延缓骨外转移的发生.单发骨转移是乳腺癌单纯骨转移患者的独立良好预后因素.内分泌治疗能够改善激素受体阳性乳腺癌单纯骨转移患者骨转移后生存.

Objective To explore the effect of prognosis of consolidation radiotherapy for patients after R0 resection of local recurrence after radical mastectomy. Methods Totally 110 breast cancer patients with local recurrence receiving R0 resection were admitted and treated in our hospital from January 1st, 2003 to November 30th, 2015 were retrospectively analyzed. Results The median local progression time of 74 patients receiving consolidation radiotherapy ( 67.3％) was remarkably better than that of those without radiotherapy(36 patients, 32.7％), and the difference was statistically significant (χ2 =8. 526, P<0.05). Meanwhile, there was no statistically significant difference (P>0.05) of distance disease-free survival and overall survival between the radiotherapy group and the non-radiotherapy group. Multifactor analysis indicated that pseudo-adjuvant endocrine therapy (χ2 =7.541,95％CI:27.1％ -80.4％, P <0.05), DDFS(≥2 years vs. <2 years,χ2 =4.068,95％CI:101.4％ -267％,P<0. 05) and pseudo-adjuvant radiotherapy(χ2 =14.126, 95％CI:21.7％ -80.4％, P <0. 05 ) were the independent risk factors affecting the OS of patients with local recurrence after R0 resection. Conclusions For the patients with local recurrence after R0 resection of local recurrence, it is recommended that consolidation radiotherapy should be done and the radiation field should include the same side of the chest wall and clavicle area lymphatic drainage area.

Objective:To investigate the expression of naive and memory T cells in peripheral blood of patients with non-small cell lung cancer (NSCLC) treated with radiotherapy and their prognostic value. Methods:Pretreatment peripheral blood samples obtained from 40 patients with NSCLC treated via radiotherapy and 14 healthy controls were analyzed by flow cytometry for naive CD4+T cells, memo-ry CD4+T cells, naive CD8+T cells, and memory CD8+T cells. We evaluated the relationships between these cells and patient character-istics and the prognosis of patients. Results:Compared with healthy controls, patients with NSCLC showed decreased naive CD4+T cells (P=0.031) and increased memory CD4+T cells (P=0.014) and memory CD8+T cells (P=0.005). Smokers showed lower naive CD4+T cells (P=0.063) and higher memory CD4+T cells (P=0.024) than nonsmokers. Patients with good performance status exhibited decreased na-ive CD8+T cells (P=0.017) and increased memory CD8+T cells (P=0.020). Univariate analysis revealed that increased naive CD4+T cells were correlated with better progression-free survival after radiotherapy (17 vs. 9 m, P=0.044), whereas elevated memory CD4+T cells may be correlated with poor progression-free survival after radiotherapy (9 vs. 15 m, P=0.069). Multivariate analysis demonstrated that naive CD4+T cells were independently associated with progression free survival after radiotherapy (P=0.009). Conclusion:Patients with NSCLC showed decreased naive T cells and increased memory T cells. Elevated naive CD4+T cells may predict longer progression free survival after radiotherapy.

Objective To investigate the incidence of and high-risk factors for hippocampal metastasis (HM) in patients with brain metastases of lung cancer,to determine the safety of hippocampussparing whole brain radiotherapy (HS-WBRT),and to find out patients eligible for HS-WBRT.Methods A retrospective study was performed on clinical data from 345 patients with brain metastases of lung cancer who were admitted to our hospital from 2011 to 2014.The hippocampus plus a 5-mm margin was delineated.Univariate and multivariate logistic analyses were used to identify high-risk factors for hippocampal metastasis.The Cox model was used for multivariate prognostic analysis.Results In the 345 patients,there were 1621 intracranial metastatic lesions.Sixteen (4.6％) of the 345 patients and 16(0.99％) of the 1621 intracranial metastatic lesions had hippocampal metastasis;42(12.2％) of the 345 patients and 45(2.78％)of the 1621 intracranial metastatic lesions had metastasis in the hippocampus plus a 5-mm margin.The univariate and multivariate logistic analyses showed that the number of brain metastases was correlated with hippocampal metastasis (HR=1.14,P=0.000).In the 139 patients with intracranial progression after treatment,17 (12.2％) had hippocampal metastasis recurrence.The Cox prognostic analysis showed that tumor stage and genetic information were related to the overall survival in patients with brain metastases.Conclusions The number of brain metastases is a high-risk factor for hippocampal metastasis.The lung cancer patients with more brain metastases have a higher incidence of hippocampal metastasis.HS-WBRT is recommended for lung cancer patients with fewer brain metastases,early-stage disease,and genetic mutations or rearrangement.

目的:探讨应用直线加速器调强技术实现全脑放疗并对海马保护.方法:选取8例接受全脑放疗+海马保护的乳腺癌脑转移患者,进行全脑临床靶区(CTV)和海马区的勾画,全脑外扩5mm形成计划靶区(PTV),海马区外扩5mm形成海马保护区域.利用Varian Eclipse 7.6治疗计划系统设计10野调强计划,处方剂量为3000 cGy/10F.结果:8例病人的PTV V90平均值为99.5％,V95平均值为98.4％,均匀性指数平均值为0.09.海马平均体积为5.0 cm3,海马保护区域平均体积为26.2 cm3,占全脑体积的1.8％.海马的平均剂量为17.1 Gy,最大剂量为21.7 Gy;海马保护区域的平均剂量为22 Gy,最大剂量为29.3 Gy.海马平均剂量为靶区处方剂量的57％,海马保护区域平均剂量为靶区处方剂量的73％.晶体最大剂量平均值为6Gy.结论:在全脑放疗中,利用直线加速器调强技术能在保证靶区剂量覆盖和靶区均匀性的情况下降低海马受照剂量,实现神经认知功能的保护.

目的:探究影响乳腺癌保乳放疗选择调强放疗（IMRT）与常规切线野放疗（CR）的影响因素。方法:选取30例左乳癌保乳放疗患者,每一例患者均设计IMRT与CR两种计划方案,根据计划结果,按照一定的评估标准,分为适合IMRT组（A组）、适合CR组（B组）、IMRT与CR均可组（C组）3组,将靶区PTV体积大小、沿胸壁的弧度、射野中心距胸骨中线的距离、PTV内弧直径距离作为选择不同治疗方式的4个影响因素进行分析。结果:非参数检验结果显示体积有显著性差异（P=0.047＜0.050）,距胸骨中线的距离显著性影响较弱（P=0.057＞0.050）;A组11例病例的PTV体积范围为424~780cm~3,B组7例病例PTV体积范围为317~665 cm3。结论:PTV体积是选择适合IMRT计划或适合CR计划的明显影响因素,距胸骨中线的距离d1影响较弱,但无法找出一个明确的体积范围。

目的 探讨不同分子亚型乳腺癌脑转移(BCBM)患者的临床特点和预后.方法 收集201例BCBM患者的临床资料,根据原发肿瘤激素受体及表皮生长因子受体2(HER-2)表达状态,将患者分为3个不同分子亚型,并分析不同亚型BCBM患者的临床特征及生存情况.结果 201例患者中,Luminal型68例(33.8％),HER-2型87例(43.3％),三阴型46例(22.9％).全组患者初始转移部位依次为肺68例(33.8％)、骨63例(31.3％)、肝52例(25.9％)和脑27例(13.4％).不同亚型患者初始转移部位不同(P＜0.05),Luminal型患者骨转移的发生率最高(41.2％),HER-2型肝转移的发生率为35.6％,三阴型患者脑转移的发生率为30.4％.不同亚型患者首次复发至出现脑转移时间(TTBM)不同Luminal型为18.1个月,HER-2型为16.8个月,三阴型患者为8.3个月,差异有统计学意义(P=0.005);Luminal型患者总生存时间为95.7个月,HER-2型总生存时间为72.2个月,三阴型患者总生存时间为41.6个月,差异有统计学意义(P=0.002).HER-2型患者脑转移前采用抗HER-2治疗的TTBM为21.9个月,较未行抗HER-2治疗的TTBM(7.2个月)明显延长(P=0.002).结论 肺、骨、肝和脑是乳腺癌最常见的远处转移部位.三阴型乳腺癌患者容易发生脑转移且预后最差,三阴型和HER-2型未行抗HER-2治疗患者容易早期出现脑转移,抗HER-2治疗可以延缓脑转移的发生.

Objective: Radiation recall dermatitis (RRD) occurs in a previously irradiated field and is triggered by certain cytotoxic drugs or target drugs. A case of RRD caused by treatment with erlotinib 21 days after whole brain radiation therapy (WBRT) is reported. PATIENT AND Methods: A 56-year-old female patient with boon metastase of non-small cell lung cancer (T3N2M1) was found brain metases in MRI without symptom 3 months after diagnosis. She was treated with WBRT (Dt40Gy/20f/4weeks) and erlotinib (150mg/day) thereafter. Results:The patient developed rash, folliculitis and localized infection in her head skin 21 days after the first dose of erlotinib (grade 3 Radiation Therapy Oncology Group scoring criteria). The severity lesions were localized to head skin which limited in scope of WBRT. Erlotinib was stop and treatment to lesions was applied. The diagnosis of RDD induced by erlotinib was made. Conclusion:The use of Erlotinib after RT may trigger RRD. We advise clinicians to be cautious of RRD after erlotinib treatment. The drug should be unused and the treatment to severity lesions should be applied.

A 55-year-old female patient received an IV infusion of docetaxel 140 mg for lymph nodes,bones,and liver metastases after operation of breast cancer.In the morning of day 6 after chemotherapy,she developed a lot of fresh blood in her stool.Her heart rate was 120 beats/min.Her routine blood tests showed the following levels;white blood cell count 0.9×10~9/L,hemoglobin 103 g/L, platelet count 62×10~9/L.She received an IV injection of hemocoagulase 2 U and an Ⅳ infusion of aminomethylbenzoic acid 0.2 g immediately.In the noon of the same day,a lot of fresh blood appeared in the patient's stool again and she felt palpitation and fatigue.Routine blood tests showed a white blood cell count of 0.5×10~9/L,a hemoglobin level of 75 g/L,and a platelet count of 52×10~9/L.She received enema with Yunnanbaiyao(云南白药) 1 g + lyophilized thrombin powder 4000 U + iced saline 100 ml every 2 h;continuous Ⅳ infusion of somatostatin 3 mg for 12 h;transfusion of suspended red blood cells 2 U and apheresis platelets 1 U.The electron colonoscopy scanning showed multiple rectal ulcers with one site of bleeding.Then endoscopic hemostasis was performed,and no bleeding recurred.

Objective To evaluate the efficacy of docetaxel in patients with paclitaxel-resistant metastatic breast cancer.Methods 60 clinical records of metastatic breast cancer patients with paclitaxel-resistance were summarized retrospectively and the clinical effects and influencing factors of docetaxel were statistically analyzed.Results The median age was fifty-one years in the whole group.The positive rate of estrogen receptor or progesterone receptor was 65%,and the positive status of Her-2 was 28.3%.The objective response rates and the clinical benefit rates of docetaxel in patients with paclitaxel-resistant metastatic breast cancer were 18.3% and 25.0%,and the median progression-free survival(PFS) was 4.0(3.38-4.62)months.There was no difference between the effects of primary paclitaxel-resistant group and secondary paclitaxel-resistant group not only in objective response rates,but also in clinical benefit rates(P=1.000;P=0.762).However,the PFS of the latter was superior to the former(2 months vs 6 months,P=0.008).Cox regression showed that the PFS of docetaxel had no association with the dose of body surface area per units,age,pathological type,status of estrogen/progesterone receptor,status of Her-2,lymph node metastatic status in patients with paclitaxel-resistant metastatic breast cancer,but was correlated with the resistance to paclitaxel,disease-free survival,treatment lines,clinical stages(P=0.001;P=0.029;P=0.037;P=0.034).Conclusion Paclitaxel-resistant patients underwent docetaxel treatment still obtained certain objective response rates and clinical benefit rates,and the paclitaxel and docetaxel were partially cross-resistant in patients.

目的:评价孕激素类药物解救治疗第三代芳香化酶抑制剂(Ais)耐药的复发转移性乳腺癌的临床疗效.方法:回顾性 分析了本院自 2000年 1月至 2010年 12月,87例接受孕激素类药物解救治疗 Ais耐药的复发转移性乳腺癌的临床资料,对临床疗 效、影响疗效的因素以及不同孕激素类药物疗效差别等进行了分析.结果:87例孕激素类药物解救治疗第三代 Ais耐药的复发转 移性乳腺癌患者,临床获益率 21.8%,中位无进展生存期(PFS)3.0(2.5～3.5)个月.第三代 Ais解救治疗是否获益与孕激素类药 物 PFS无关(P=0.796),第三代 Ais未获益者后接受孕激素类药物解救治疗仍然有 22.8%患者临床获益.两种孕激素类药物甲羟 孕酮、甲地孕酮有效率、临床获益率、PFS无差异(P=0.595,0.737,0.664).Cox多因素分析显示孕激素类药物 PFS与术后病理分 型、同侧腋窝淋巴结转移状态、年龄、ER/PR状态、Her-2状态、是否接受辅助治疗等因素均无关相关性.结论:孕激素类药物是解 救治疗芳香化酶抑制剂(Ais)耐药的转移性乳腺癌的重要治疗选择.

Objective To evaluate the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermis growth-factor receptor 2(HER-2), to determine the phenotype transformation of these receptors before and after recurrence and/or metastasis, and to explore the effects of expression and phenotype transformation of receptors on the treatment efficacy and clinical prognosis of patients with breast cancer. Methods Based on the phenotype transformation of ER, PR, and HER-2 receptor, 211 breast cancer patients were assigned to 3 groups. Twenty patients of Group A were with primary triple-negative breast cancer (TNBC, defined as lacking expression of ER, PR and HER2) which transformed into non-TNBC after recurrence and/ or metastasis, 73 of Group B were with primary non-TNBC which transformed into TNBC after recurrence and/or metastasis, and 118 of Group C were with primary TNBC which was still TNBC after recurrence and/or metastasis. The phenotype transformation of receptors, recurrence/metastasis, and efficacy and clinical prognosis were analyzed following collection of general information of the patients. Results The median age of 211 recurrent patients was 52 years (range, 22 to 78 years). Most of the patients exhibited solitary metastasis. The most common locations of the initial metastasis were lymph node, bone and skin. The median disease-free survival for Groups A, B, and C was 34.0, 25.0, and 20.0 months, respectively. The clinical effect of Groups B and C was better than that of Group A for first-line, second-line, and third-line rescuing therapy (P=0.030, 0.003, 0.001). However, the clinical benefit rate of Group A was higher than those of Groups B and C for rescuing endocrine therapy. The median follow-up time of the 211 patients was 68 months (range, 20 to 127 months), and the median survival after recurrence for Groups A, B, and C was 63.1, 33.7, and 25.8 months respectively (P=0.000). The median overall survival for Groups A, B, and C was 156.7, 67.8, and 47.4 months respectively (P=0.000). Conclusions The phenotype transformation of ER, PR and HER-2 may influence the clinical prognosis of patients with breast cancer. Therefore, the expression of ER, PR and HER-2 should be determined to ensure the efficacy of rescuing therapy.

患者女,58岁,因右乳腺癌术后半个月余入院.在外院(二级医院)经穿刺病理证实为乳腺癌,疗前分期Ⅰ期(T_1N_0M_0期);第1～4天行单药氟尿嘧啶1000mg新辅助化疗,1周期未评价疗效后即行右乳腺癌改良根治术,并由外科医生行~(125)Ⅰ籽源植入术(1.78×10~7 Bq/个,腹直肌前鞘2个,胸大小肌间2个,肿物下方胸壁2个,右腋窝4个;放射剂量等不详)。