【摘要】 目的　探讨高剂量化疗 (HDC)联合自体造血干细胞移植 (AHSCT)治疗复发和高危乳腺癌的疗效和安全性。方法　对 13例复发和高危乳腺癌患者进行了HDC联合AHSCT治疗 ,其中 7例为既往治疗失败的复发转移患者 ,2例为姑息性乳房切除术后的Ⅳ期患者 ,4例为根治性乳房切除术后腋淋巴结转移 10个以上的Ⅱ、Ⅲ期患者。4例进行了自体骨髓移植 ,6例作了自体外周血干细胞移植。预处理方案为噻替哌 5 0 0 ( 2 5 0～ 60 4 )mg/m2 、环磷酰胺 4 9( 3 3～ 6 0 )g/m2 ,8例加用卡铂 80 0 ( 4 0 0～80 0 )mg/m2 ,2例将噻替哌换成足叶乙甙 83 0 ( 80 0～ 860 )mg/m2 。移植后 12例行内分泌治疗 ,2例姑息切除术后和 4例根治切除术后患者行胸壁和乳腺淋巴引流区放疗。结果　中位随访 8( 1～ 4 7)个月 ,7例复发转移患者诱导化疗后 4例完全缓解 (CR)、3例部分缓解 (PR) ,PR患者移植后亦获CR ,7例无病生存 1～3 1个月 ;2例姑息切除术后患者诱导化疗后 1例CR ,1例进展 (PD) ,PD患者移植后获PR ,经局部放疗后分别无病生存 5和 2 2个月 ,4例根治切除术后患者移植后均持续无病生存 1～ 4 7个月。结论　HDC联合AHSCT是复发和高危乳腺癌一种值得继续探索的治疗方法。更多还原

【Abstract】 Objective to evaluate the therapeutic effectiveness and safety of combined high dose chemotherapy (HDC) with autologous hematopoietic stem cell transplantation (AHSCT) for recurrent and high risk breast cancer. Methods Thirteen patients with recurrent or high risk breast cancer underwent HDC with AHSCT. Seven cases had relapsed metastasis who had failed in the previous chemotherapy. Two cases had stage Ⅳ disease who had received palliative excision. Four cases had stage Ⅱ or Ⅲ breast cancer with over 10 positive axillary lymph nodes who had received radical surgical resection. Four cases received autologous bone marrow transplantation, and six received autologous peripheral blood stem cell transplantation. The consolidation regimen was Thiotepa 500 (250～604) mg/m 2, Cyclophosphamide 4.9 (3.3～6.0) g/m 2. Eight cases were also given Carboplatin 800 (400～800) mg/m 2, and two received Etoposide 830 (800～830) mg/m 2 instead of Thiotepa in the consolidation regimen. Twelve cases underwent endocrinotherapy after HDC with AHSCT, six operated cases underwent radiotherapy in the area of chest wall and regional lymph nodes after HDC with AHSCT. Results After a median follow up of 8(1～47) months, four cases achieved complete remission (CR) and 3 achieved partial remission (PR) in the 7 cases with relapsed metastasis after induction of chemotherapy, PR patients achieved CR after HDC with AHSCT. The disease free survival (DFS) was 1～31 months in these 7 cases. One of two stage Ⅳ cases achieved CR and the other had progressive disease (PD) after induction chemotherapy, but the PD patient achieved PR after HDC with AHSCT, they underwent local radiotherapy after HDC with AHSCT and DFS was 5 and 22 months, respectively. The DFS was from 1～47 months in 4 cases with stage Ⅱ or Ⅲ disease. Conclusion HDC with AHSCT is a highly potential therapeutic means for recurrent and high risk breast cancer paitents.更多还原