Clinical Application of Neo-adjuvant Endocrine Therapy for Locally Advanced Breast Cancer in Elderly Patients_West China Medical Journal

Authors：

LONG Qiming ,  ZHANG Jianhui

Second Ward of the Department of Mammary Gland, Sichuan Provincial Cancer Hospital, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZHANG Jianhui, Email: long6177@yahoo.com.cn

Keywords：

老年性乳腺癌; 術前治療; 內分泌治療; 芳香化酶抑制劑

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【摘要】　目的　探討老年性乳腺癌術前內分泌治療效果及降期后手術優點。　方法　 2004年5月－2010年12月19例老年性局部晚期乳腺癌患者，術前給予口服芳香化酶抑制劑（aromatase inhibitors，AI）2～10個月，進行療效觀察，降期后手術及術后同一有效內分泌藥物繼續治療并隨訪，時間1～66個月。　結果　自AI治療開始至手術時，臨床完全緩解2例，部分緩解11例，穩定3例，進展3例；手術14例，另5例由于全身狀況差、基礎疾病嚴重不能耐受手術或局部進展而放棄手術，5年總生存率68%，無瘤生存率47%。　結論　術前內分泌治療療效可靠，不良反應輕，特別適應老年伴有內科疾病不適應化學療法的患者，可以增加保乳手術率和手術切除率。
【Abstract】　Objective　 To investigate the clinical value of neo-adjuvant endocrine therapy for locally advanced breast cancer in elderly patients and the advantages of operation after down-staging of breast cancer.　Methods　 From May 2004 to December 2010, 19 patients with locally advanced breast cancer were treated with Aromatase inhibitor (AI) neo-adjuvant endocrine therapy for 2 to 10 months before operation. The clinical efficacy was observed. Operation was performed after down-staging of the cancer. After the operation, patients continued taking the same effective drug and were followed-up for 1 to 66 months.　Results　 From AI treatment to the time of operation, there were 2 cases of clinical complete response, 11 cases of clinical partial response, 3 cases of stable disease, and 3 cases of progressive disease. A total of 14 patients were operated, and 5 other patients could not have the operation for bad body conditions, serious basic-diseases or local progress of the disease. The 5-year overall survival rate was 68%, and the disease-free survival rate was 47%.　Conclusion　 Neo-adjuvant endocrine therapy has a reliable clinical effect and low side-effects. It is especially suitable for elderly patients excluded from chemotherapy because of internal medical diseases. It can also increase the rate of breast-conserving and surgical excision.

Citation： LONG Qiming,ZHANG Jianhui. Clinical Application of Neo-adjuvant Endocrine Therapy for Locally Advanced Breast Cancer in Elderly Patients. West China Medical Journal, 2011, 26(7): 975-978. doi: Copy

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2.	Clotz LH, Herr HW, Morse MA, et al. International endocrine therapy for advanced prostate cancer[J]. Cancer, 1986, 58(11): 2546-2550.
3.	張柏林, 劉海潔, 張保寧. 乳腺癌新輔助內分泌治療進展[J]. 醫學研究雜志, 2010, 39(2): 13-16.
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10.	Smith IE, Dowsett M, Ebbs SR, et al. Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial[J]. J Clin Oncol, 2005, 23(22): 5108-5116.
11.	Semiglazov VF, Semiglazov VV, Ivanov VG, et al. Exemestane(E) vs tamoxifen(T) as neoadjuvant endocrine therapy for postmenopausal women with ER+ breast cancer (T2NH, T3N0-1 T4 NOMO)[J]. J Clin Oncol, 2005, 23(165): 530.
12.	Dixon JM, Jackson J, Renshaw L, et al. Neoadjuvant tamoxifen and aromatase inhibitors: comparisons and clinical outcomes[J]. J Steroid Biochem Mol Biol, 2003, 86(3-5): 295-299.
13.	Fennessy M, Bates T, MacRae K, et al. Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancer[J]. Br J Surg, 2004, 91(6): 699-704.
14.	Mustacchi G, Ceccherini R, Milani S, et al. Tamoxifen alone versusadjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase Ⅲ randomized controlled multicenter GRETA trial[J]. Ann Oncol, 2003, 14(13): 414-420.
15.	Kaufmann M, Hortobagyi GN, Goldhirsch A, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update[J]. J Clin Oncol, 2006, 24(12): 1940-1949.
16.	Paepke S, Tulusan A, Kiesel L, et al. A multi-center study of pre-operative treatment with letrozole for optimal duration of treatment in postmenopausal women with ER and/or PGR positive breast cancer[J]. Proc Am Soc Clin Oncol, 2003, 22: 321.

1. 　薛衛成, 闞秀, 介紹乳腺癌TNM分期系統(第6版)[J]. 診斷病理學雜志, 2008, 15(3): 161-164.
2. 　Clotz LH, Herr HW, Morse MA, et al. International endocrine therapy for advanced prostate cancer[J]. Cancer, 1986, 58(11): 2546-2550.
3. 　張柏林, 劉海潔, 張保寧. 乳腺癌新輔助內分泌治療進展[J]. 醫學研究雜志, 2010, 39(2): 13-16.
4. 　Horobin JM, Preece PE, Dewar JA, et al. Long term follow-up of elderly patients with locoregional breast cancer treated with tamoxifen only[J]. Br J Surg, 1991, 78(2): 213-217.
5. 　Diab SG, Elledge RM, Clark GM. Tumor characterstics and clinical outcome of elderly women with breast canaer[J]. J Natl Cancer Inst, 2000, 92(7): 550-556.
6. 　Semiglazov VF, Semiglazov VV, Dashyan GA, et al. Phase 2 radomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor positive breast cancer[J]. Cancer, 2007, 110(2): 244-254.
7. 　Gazet JC, Markopoulos C, Food HT, et al. Prospective randomized trial of tamxifen vs surgery in elderly patients with breast cancer[J]. Eur J Surg Oncol, 1994, 20(3): 207-214.
8. 　Eiermann W, Paepke S, Appfelstaedt L, et al. Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomized double-blind multicenter study[J]. Ann Oncol, 2001, 122(11): 1527-1532.
9. 　Cataliotti L, Buzdar A, Noguchi S, et al. Comparison of anastrozole versus tamoxifen as preoperative therapy in postmenopausal women with hormone receptor-positive breast cancer: the Pre-Operative “Arimidex” Compared to Tamoxifen (PROACT) trial[J]. Cancer, 2006, 106(10): 2095-2103.〖ZK)〗.
10. 　Smith IE, Dowsett M, Ebbs SR, et al. Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial[J]. J Clin Oncol, 2005, 23(22): 5108-5116.
11. 　Semiglazov VF, Semiglazov VV, Ivanov VG, et al. Exemestane(E) vs tamoxifen(T) as neoadjuvant endocrine therapy for postmenopausal women with ER+ breast cancer (T2NH, T3N0-1 T4 NOMO)[J]. J Clin Oncol, 2005, 23(165): 530.
12. 　Dixon JM, Jackson J, Renshaw L, et al. Neoadjuvant tamoxifen and aromatase inhibitors: comparisons and clinical outcomes[J]. J Steroid Biochem Mol Biol, 2003, 86(3-5): 295-299.
13. 　Fennessy M, Bates T, MacRae K, et al. Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancer[J]. Br J Surg, 2004, 91(6): 699-704.
14. 　Mustacchi G, Ceccherini R, Milani S, et al. Tamoxifen alone versusadjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase Ⅲ randomized controlled multicenter GRETA trial[J]. Ann Oncol, 2003, 14(13): 414-420.
15. 　Kaufmann M, Hortobagyi GN, Goldhirsch A, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: an update[J]. J Clin Oncol, 2006, 24(12): 1940-1949.
16. 　Paepke S, Tulusan A, Kiesel L, et al. A multi-center study of pre-operative treatment with letrozole for optimal duration of treatment in postmenopausal women with ER and/or PGR positive breast cancer[J]. Proc Am Soc Clin Oncol, 2003, 22: 321.

West China Medical Journal

Clinical Application of Neo-adjuvant Endocrine Therapy for Locally Advanced Breast Cancer in Elderly Patients

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