| Objective:Breast cancer incidence is among the top of the female malignant tumors and its incidence increased year by year. The incidence of locally advanced breast cancer (LABC) can still reach more than 30% in the developing countries. It mainly refers to the mass is more than 5 cm, with skin or chest wall invasion, axillary lymph nodes can hit a fixed and supraclavicular lymph node enlargement, the contralateral breast medial quadrant transfer, but there is no distant metastasis of cancer. Neoadjuvant Chemotherapy (NACT) refers to the systemic cytotoxic drugs treatment before the application of topical treatments for the breast cancer without metastatic tumors. Cytotoxic drugs, such as taxol anthracycline-based drugs used in combination with neoadjuvant chemotherapy in advanced breast cancer treatment effectiveness can reach 40%-70%. The present study was to identify the curative effect of anthracycline and taxol anthracycline drugs on LABC taxol. We retrospectively analyzed combination or sequential clinical results and side effects of epirubicin (anthracycline-based drug) and docetaxel (paclitaxel drug), and comparasion of the curative effect and side effect of two different regimens, in order to complement the curative effect in the neoadjuvant chemotherapy in the treatment of LABC clinical data.Methods:We retrospectively analysed locally advanced 118 cases of female breast cancer (LABC) patients. The basic information of the selected patients, clinical stage, estrogen receptor (estrogen receptor, ER) and progesterone receptor, progesterone receptor, PR) state, preoperative chemotherapy regimens type and cycles of chemotherapy were collected. The patients were divided into combination group of 72 cases and sequential group of 46 cases. The regimens used forNACT were, six cycles of DEC (docetaxel 75 mg/m2, epirubicin 75 mg/m2, cyclophosphamide 500 mg/m2 for every 3 weeks) and a sequential regimen (4 cycles of FEC,5-flurouracil 600 mg/m2, epirubicin 75 mg/m2, cyclophosphamide 600 mg/m2 followed by 4 cycles of docetaxel 75 mg/m2). The short-term curative effects, long term curative effects and and adverse reaction rates were evaluated after chemotherapy.Core quality of life questionnaire(QLQ-C30) 4 weeks after treatment.Recent curative effects were divided into clinical complete response, clinical partial response, stable disease, disease progression and pathological complete response. Long term curative effects included survival rates of 1 year and 3 years and recurrence time. Relapse-free survival referred to the time from operation to recurrence or death. Adverse reactions include nausea and vomiting, neutropenia, kidney damage, etc. X2 test, t test log-rank test were used. P< 0.05 represented for the difference with statistically significance.Results:1. Clinical and histological features of patients:the ages were between 24 and 75 years old, with an average age of 46. Patients with right tumor were 60 and with left side were 58. Premenopausal cases were 52 (44%). Symptoms lasted for an average of 6 months (1～66 months). The clinical data were comparable between the two groups of patients (P> 0.05).2. Comparison of short-term curative effects:in the two groups,98 cases showed clinical complete or partial response, accounting for 83.1%,15 cases of stable disease, 5 cases of disease progression,18 cases of pathological level. Clinical and pathological response rates of the two groups showed no statistical difference. Total clinical response rate of ER and PR negative patients was 90%, and that of ER and PR positive patients was 70%, showing no statistical difference.3. Comparison of long-term curative effects:the average recurrence time was about 20 months. Patients without recurrence in 3 years were about 50%.1 year overall survival rate was 87.3% and total survival rates were 70.3% at 3 years. Specific as follows in the two groups:recurrence time in combined group averaged 19.7 months, without recurrence cases in 3 years accounted for 48%,1 year survival rate was 88.9%, and 3 year survival rate was 70.8%. In sequential group, recurrence time averaged 21.4 months, without recurrence cases in 3 years accounted for 51%,1 year survival rate was 84.8%, total survival rates were 69.6% at 3 years. The survival rate in the two groups of patients showed no statistical difference.4. Comparison of adverse reaction:patients in both of the combined group and sequential group had adverse reactions of different degree, including neutropenia,2 to 3 degrees such as nausea and vomiting, among which about 15% of the patients in combined group had a joint of neutropenia and fever, statistically significant difference (P< 0.05) compared with the sequential group. At the same time,5 patients died of toxic effects in combined group.5. Comparison of QLQ-C30 scores:After treatment, the allomeric function,scores of symptom specific modules of QLQ-C30 scores were better compared with those before treatment in the 2 groups(P<0.05);and after treatment all the above scores in the sequential group were better than those in the combined group(P<0.05);After treatment, the degree of pain were lower compared with those before treatment in the 2 groups(P<0.05) after treatment the degree of pain in the observation group were better than those in the control group(P<0.05).Conclusions:1. Combined or sequential use of docetaxel and epirubicin as the neoadjuvant chemotherapy of locally advanced breast cancer is both effective.2. Effect of combined and sequential use of docetaxel and epirubicin as the neoadjuvant chemotherapy of locally advanced breast cancer showed no difference as the neoadjuvant chemotherapy of locally advanced breast cancer is both effective.3. As the neoadjuvant chemotherapy of locally advanced breast cancer, the adverse reactions of sequential use of docetaxel and epirubicin were lighter, and patients showed better tolerability.4. As the neoadjuvant chemotherapy of locally advanced breast cancer, the Quality of life of sequential use of docetaxel and epirubicin were better. |
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