OPTION FOR TREATING LOCALLY ADVANCED PRIMARY BREAST CANCER
About the author:
Bashtan V. P., Zhukova T. O., Mukovoz O. E., Litvinenko V. E., Aipert V. V.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The first place in the ranking of oncology and the most acute oncology problem is breast cancer (BC), in the vast majority of women. The rate of abstinence is high, and the percentage of patients receiving special therapy is 80.4%. All this indicates a low level of qualified care (Kolesnik O.O., Fedorenko Z.P., 2017). The aim of the study was the desire to study the effectiveness of various schemes of preoperative chemoradiation therapy with radiomodification in the scheme of complex treatment of primary localized BC. The object and methods of research. For the period from 2011 to 2016, in the conditions of the Poltava Regional Clinical Oncology Center, 89 patients with primary, inoperable, localized BC in the 3rd stage (T3-4N0-1M0), with compulsory verification of the process, received radiomodified chemoradiotherapy. Patients in both groups were recruited by blind randomization and divided into 2 groups. All patients were taken into work after signing, as a matter of compulsory, informed consent to the study. I (n-42) group received 2 courses of chemotherapy (CT) at standard doses of the CMF scheme. After 2 weeks of rest, patients received a course of radiation therapy under the radical program: on the axillary lymph nodes, parasternal supraclavicular areas, a single focal dose (SFD) of 2.2 Gr. to a total focal dose (TFD) of 60-62 Gr. II (n-47) group of patients received 2 courses of chemotherapy (CT) at standard doses of the CAF/FAC scheme. After 2 weeks of rest, patients received a course of radiation therapy under the radical program, but in multifractional mode: on the axillary lymph nodes, parasternal supraclavicular areas, a single focal dose (SFD) of 1.1 Gr (morning) + 1.1 Gr (after 6 hours) = 2.2 Gr to the total focal dose (TFD) 60-62Gr with radiomodification Tegafur (800 mg in the morning and 400 mg in the evening), which was administered in accordance with the instructions. Research results and their discussion. Analyzing 1 year of supervision, it is evident that 35 (83.3%) patients died in the I group, 7 died (16.7%). Patients who did not have a recurrence of the process at 1 year of life 25 (59.92%). In the II group, they died at 1 year – 6 (12.76%), and patients without relapsing 36 (76.59%). Comparing the result clearly that the overall survival of a reliable result was not low, and the rate of recurrence is likely to speak for the benefit of Group II. During second year, another 14 patients died in Group І against 7 group II. In the I survived, 21 (50,0%) were left, of which 17 (40,47%) without relapse were against 34 (72,34%) of the live ones, of which 20 (42,55%) without relapse. Summing up our research, supervision over the results of treatment in two groups, we can say that the remote survival results show the following: for 36 months. The observation formed the number of patients who clearly showed the results of treatment in groups I and II. In group І, overall survival rate was 11 (26,19%), with relapse 4 (9,52%). In the II group, the total number of patients with 3 years of observation was 25 (53,19%), with relapse of 17 (36,17%). Conclusions. The study of the effectiveness of the scheme of neoadjuvant chemotherapy in combination with radiotherapy and radiomodification (group II) showed a positive trend in survival and relapse rates as well as a satisfactory state in the manifestations of toxicity of HT and radiation manifestations compared with the proposed scheme for group I.
neoadjuvant chemotherapy, primary inoperable breast cancer, breast, multifractionation, radiomodification
- Kaprin AD, Starinskii BV, Petrova GV, redaktory. Zlokachestvennye novoobrazovaniia v 2014 godu (zabolevaemost i smertnost). Moskva: MNIOI im. P. A. Gertcena; 2015. 250 s. [in Russiаn].
- Arias-Pulido H, Chaher N, Gong Y, Qualls C, Vargas J, Royce M. Tumor stromal vascular endothelial growth factor A is predictive of poor outcome in inflammatory breast cancer. BMC Cancer. 2012;12:298.
- Lai J, Wang H, Peng J, Chen P, Pan Z. Establishment and external validation of a prognostic model for predicting disease-free survival and risk stratification in breast cancer patients treated with neoadjuvant chemotherapy. Cancer Manag Res. 2018;10:2347-56.
- Moo TA, Sanford R, Dang C, Morrow M. Overview of Breast Cancer Therapy. PET Clin. 2018;13(3):339-54.
- Kahraman M, Röske A, Laufer T, Fehlmann T, Backes C, Kern F, et al. MicroRNA in diagnosis and therapy monitoring of early-stage triplenegative breast cancer. Sci Rep. 2018;8(1):11584.
- Stenina MB, Frolova MA, Kupchan DZ, Tiuliandin SA. Izmeneniia v neo-i adiuvantnom lechenii raka molochnoi zhelezy za poslednie 5 let. Prakticheskaia onkologiia. 2017;18(3):256-64. [in Russiаn].
- Portnoi SM. Mestnorasprostranennyi rak molochnoi zhelezy (taktika lecheniia). Vopr. onkologii. 2011;57(5):553-8. [in Russiаn].
- Semiglazov VF, Semiglazov VV. Rak molochnoi zhelezy: biologiia, mestnoe i sistemnoe lechenie. Moskva: Spetcialnoe izdvo meditcinskikh knig; 2014. 347 s. [in Russiаn].
- Holgado E, Perez-Garcia J, Gion M, Cortes J. Is there a role for immunotherapy in HER2-positive breast cancer? NPJ Breast Cancer. 2018;4:21.
- Sedakov IE, Pominchuk DV, Smirnov VN, Motrii AV, Skochilias TL, Volkova NV, i dr. Izmenenie biologicheskikh svoistv opukholi mestno-rasprostranennogo raka molochnoi zhelezy na fone provedeniia neoadiuvantnogo lecheniia. Novoobrazovanie. 2017;15(2):50-3. [in Russiаn].
- Chaher N, Arias-Pulido H, Terki N, Qualls C, Bouzid K, Verschraegen C, et al. Molecular and epidemiological characteristics of inflammatory breast cancer in patients. Breast Cancer Res. Treat. 2012;15:437-44.
- Dawood S, Ueno NT, Valero V, Andreopoulou E, Hsu L, Lara J, et al. Incidence of and survival following brain metastases among women with inflammatory breast cancer. Ann. Oncol. 2010;21(12):2348-55.
- Huang SY, Franc BL, Harnish RJ, Liu G, Mitra D, Copeland TP, et al. Exploration of PET and MRI radiomic features for decoding breast cancer phenotypes and prognosis. NPJ Breast Cancer. 2018;4:24.
- Vasko LM, Zhukova TO, Pilipenko NS, Pocherniaеva VF. Zastosuvannia sistemi BI-RADS dlia otcіnki danikh magnіtno-rezonansnoі mamografіі. Radіologіchnii vіsnik. 2017;3-4(64-65):85-6. [in Ukrainian].
- Shchipakhina IaA, Kochergina NV, Ivankina OV, Karpova MS, Bludov AB. Distantcionnaia tekhnologiia skrininga raka molochnoi zhelezy s ispolzovaniem rentgenovskoi mammografii. V: Aktualnye voprosy eksperimentalnoi i klinicheskoi onkologii: sb. materialov Vserossiiskoi konf. molodykh uchenykh-onkologov, posviashchennoi pamiati akademika RAMN N.V. Vasileva. Tomsk; 2016. s. 199-202. [in Russiаn].
- Ignatova EO, Frolova MA, Stenina MB, Glazkova EV, Petrovskii AV, Krokhina OV, i dr. Effektivnost i toksichnost alterniruiushchego mnogokomponentnogo rezhima neoadiuvantnoi khimioterapii mestnorasprostranennogo raka molochnoi zhelezy s troinym negativnym fenotipom. Zlokachestvennye opukholi. 2018;7(4):29-40. [in Russiаn].
- Rumiantcev AA, Ivanov VG. Iksabepilon v sovremennoi terapii rezistentnogo raka molochnoi zhelezy. Zlokachestvennye opukholi. 2018;8(1):5560. [in Russiаn].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 84-87 pages, index UDK 618.19-006-03