국소진행성 유방암의 수술전 항암요법

Abstract

The definition of locally advanced breast cancer includes stage ⅡB, ⅢA, ⅢB categories, as well as some in the stage IV category of the TNM classification. Most of these patients have very poor survival with standard treatment modalities, and over 20 years combined modality therapy have been used to improve local and systemic control. This retrospective study evaluates the clinical and pathologic responses to induction chemotherapy, and relapse as well as the relapse free survival rates of 29 patients with locally advanced breast cancer(Stage ⅢA 16, ⅢB 9, Ⅳ 4) treated with induction chemotherapy+surgery+postoperative adjuvant chemotherapy from December 1985 to August 1992. Median follow-up was 34 months(range 12-71 months). The objective response rate to induction chemo therapy was 72.4% ; 17.2% complete response(CR), 55.2% partial response(PR), 20.7% minor response(MR), and 6.9% no change(NC). However pathologic down-staging was achieved in only 51.7% of the patients. Of 14 patients with relapse, 9 were from stage ⅢA, 3 stage ⅢB, and 2 stage Ⅳ. Three patients have locoregional relapse alone, 2 locoregional as well as distant, and 9 distant alone. Four year-relapse free survival rate was 64% under ⅡB and 33% for over ⅢA (p= 0.0283) of pathological staging. This aggressive induction chemotherapy followed by surgery and postoperative adjuvant chemotherapy appears to provide encouraging early results in terms of local and systemic disease control. We suggest that the prognostic marker after induction chemotherapy is pathologic response to induction chemotherapy rather than initial clinical stage or clinical response. As a prognostic indices we suggest that a pathological response rate obtained from induction chemotherapy is important than clinical response rate or initial clinical stage.