Objective To evaluate the efficacy and toxicity of chemotherapy containing paclitaxel in patients with advanced breast cancer.Methods Chemotherapy containing paclitaxel was used in 30 patients with advanced breast cancer.Paclitaxel was administered by iv infusion at a dose of 135*!mg/m 2 in 3-hour every 3～4 weeks for an average of 4 sessions. All patients received premedication of dexamethasone, diphenhydramine and cimetidine to prevent allergic reactions. Results The overall response rate was 43%(13/30),including complete remission(CR) in 3(10%) cases and partial remission(PR) in 10(33%). The average duration of remission was 1.6 months in CR cases and 5 months in PR cases respectively.The major toxicity associated with paclitaxel administration includes neutropenia,myalgia,arthralgia, numbness of hands and feet,alopecia and flushing of face. Conclusion Paclitaxel is an effective agent for treatment of advanced breast cancer and its side effects are tolerable.

Objective To analyze the prognostic factors and their influences on breast cancer patients with local-regional recurrence.Methods From Jan.1st,1998 to Dec.30th,2007,66 breast cancer patients with local-regional recurrence were treated at Breast Center of Peking University People's Hospital.The overall survival of the patients was analyzed using Kaplan Meier survival analysis and the prognostic factors such as primary tumor status,initial treatment,location of recurrence and treatment strategy after local recurrence were analyzed using Cox regression model.Results The median follow-up was 111 months.The median survival for the 66 patients with recurrence was 99 months,ranging from 3 to 188 months and 5-year survival rate was 60％.Kaplan-Meier analysis revealed statistically significant better survival for patients with unifocal primary tumor,undergoing initial breast conservation surgery,with local recurrence only and undergoing radical local treatment after local recurrence (P =0.003,P =0.017,P =0.050,and P =0.000 respectively).COX regression analysis showed that age at initial diagnosis and radical local treatment after recurrence had influences on post-recurrence survival of patients without distant metastasis (P =O.004 and 0.000 respectively).Conclusion The clinical and pathological features of primary tumor,initial surgery,site of recurrence and treatment strategy after recurrence have influences on prognosis of breast cancer patients with local-regional recurrence.

Objective To compare the efficacy and toxicity of different cycles of neo-adjuvant chemotherapy for locally advanced breast cancer. Methods Seventy-five patients with locally advanced breast cancer were treated with epirubicin (Epi) plus paclitaxel (TAX, ET regimen). Two cycles were used in 39 patients (2 cycles group) and 4 cycles were used in 36 patients (4 cycles group). Results The overall response rate (RR) was 74% (29/39) in 2 cycles group and 94% (34/36) in 4 cycles group. One patient got clinically complete response (CR), 28 cases had partial response (PR),10 with no change (NC) in 2 cycles group, while 21 patients showed CR including 11 patients with pathologically complete response, 13 with PR, and 2 with NC in 4 cycles group. There was no progression to advanced stage in either groups. Axillary lymph nodes were palpable in all 75 patients before ET regimen, lymph nodes became non-palpable in 46% (18/39) cases in 2 cycles group and in 75% (27/36) cases in 4 cycles group. Toxicities including leukopenia, gastroenteric reactions were similar in the 2 groups, though arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group. Conclusion Neo-adjuvant chemotherapy with ET regimen for 4 cycles were more effective than 2 cycles to down staging locally advanced breast cancer. Toxicities including arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group.

Objective:To evaluate the frequency and predictive factors of nipple involvement in a large contemporary cohort of pa-tients and to improve patient selection for the preservation of the nipple-areolar complex. Methods: This retrospective study re-viewed the medical charts of 1,190 patients who underwent traditional mastectomy in Peking University People's Hospital between October 2008 and March 2014. Nipple involvement incidence was compared between the cases of clinically abnormal and clinically normal breasts. Other clinicopathological features and nipple status were analyzed to evaluate the association between these factors and occult nipple involvement. Univariate and multivariate analyses were conducted to identify predictive factors. Results:Nipple in-volvement was detected in 6.0%of the mastectomy specimens. Meanwhile, incidence was 40.7%(22 out of 54) in clinically abnormal nipple cases and 4.3%(49 out of 1,136) in clinically normal nipple cases (χ2=121.9, P<0.001). Univariate analysis revealed that tumor lo-cation, tumor to nipple distance (≤2 and>2 cm), lymphovascular invasion, diameter (including carcinoma in situ;≤3.5 and>3.5 cm), T stage, N stage, and TNM stage were associated with occult nipple involvement. By logistic regression analysis, tumor location, tumor to nipple distance, T stage, and N stage were determined to be the independent predictors of nipple involvement. Conclusion:Clinical abnormalities of the nipples are reliable and potent predictors of nipple pathology. The cases with peripheral tumor, T1-T2 stage, and N0-N1 stage have lower probability of occult nipple involvement.

With the understanding of the biological characteristics of breast cancer and the improvement of systemic treatment, the treatment concept of breast cancer has changed, and the treatment strategy of axillary lymph nodes has also been constantly changing. With the change of these concepts, a large number of relevant clinical trials have been gradually carried out. The NSABP B04 study took the lead in exploring the transformation of axillary treatment strategies in the classic breast cancer treatment. Although this study did not change the clinical practice of axillary treatment at the time, it provided a preliminary data basis for a subsequent series of clinical studies on axillary preservation. In these changes, sentinel lymph node biopsy, as a milestone in the surgical treatment of breast cancer, has become the standard staging procedure for axillary negative patients. Since then, a series of related clinical studies have also been carried out, among which the results of studies on patients with low-load axillary metastasis have confirmed the feasibility of axillary preservation in some patients, which has influenced and changed clinical practice. In addition, the results of the study make it possible for some patients to preserve the axilla after neoadjuvant therapy reduce postoperative upper extremity edema effectively. Whether axillary surgery can be completely eliminated, and whether axillary dissection can be waived for patients with positive axilla after neoadjuvant therapy under the premise of equal survival benefit have also received extensive attention.

OBJECTIVETo compare the efficacy and toxicity of two different regimens as neoadjuvant chemotherapy for breast cancer.

METHODSForty-eight patients with stage II, III breast cancer as proved by cytology biopsy, were treated with either 5-Fu, epirubicin, cyclophosphamide (FEC) or epirubicin, paclitaxel (ET) regimens for 2 cycles every 3 - 4 weeks. Clinical responses in the breast and lymph nodes were assessed after 2 cycles of neoadjuvant chemotherapy. Patients in FEC arm received combination of 5-fluorouracil (5-Fu) 500 mg/m(2) by 4-hour continuous infusion on D1 and D8, epirubicin (EPI) 50 mg/m(2) by intravenous injection on D1, and cyclophosphamide (CTX) 500 mg/m(2) by intravenous injection on D1 and D8. Patients assigned to the ET arm received EPI 60 mg/m(2) by intravenous injection on D1, paclitaxel (TAX) 150 mg/m(2) by 3-hour continuous infusion on D2. All patients were treated by operation 2 weeks later and radiotherapy was added to some.

RESULTSFor primary tumor in the breast, the overall response rate (RR) was 50.0% (12/24) in FEC arm and 79.2% (19/24) in ET arm. One patient showed clinical complete response (cCR), 11 partial response (PR), 12 no change (NC) after the FEC therapy, while 1 patient showed CR, 18 PR, 5 NC after ET therapy. There was no pathologic complete response or progressive disease, though a higher proportion of RR was observed in stage II than stage III patients in these two groups. Clinically palpable axillary lymph nodes which had been found in all 48 patients before 2 cycles of treatment, 50.0% (12/24) in the FEC patients and 66.7% (16/24) in the ET patients became in-palpable. The major toxicity, including leukopenia, gastroenteric reactions, were similar in both groups, but alopecia was more severe and arthralgia, myalgia, neurotoxicity and flushing of face were the unique features of the ET regimen.

CONCLUSIONNeoadjuvant chemotherapy with two different regimens were effective to the primary tumor and axillary metastatic lymph nodes of breast cancer, and the side effects were tolerable. Higher efficacy and more side effects are observed in ET than in FEC regimen.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Breast Neoplasms ; drug therapy ; Cyclophosphamide ; adverse effects ; therapeutic use ; Epirubicin ; adverse effects ; therapeutic use ; Female ; Fluorouracil ; adverse effects ; therapeutic use ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Paclitaxel ; adverse effects ; therapeutic use ; Taxoids ; Treatment Outcome

Objective:To explore the diagnostic value of magnetic resonance imaging (MRI) for patients with pathologic nipple discharge.Methods:A retrospective analysis was made on patients with nipple discharge who underwent breast MRI and surgical excision between Oct 2010 to Oct 2020. Sensitivity, speci?city, positive predictive value, and negative predictive value of MRI were calculated.Results:A total of 184 patients fulfilled our selection criteria, including breast cancer in 43 cases (23.4%), intraductal papilloma in 96 cases (52.2%) and other benign diseases in 45 cases (24.5%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI for intraductal lesions of pathologic nipple discharge were respectively 76.8%, 52.2%, 82.8% and 42.9%. The sensitivity, specificity, PPV and NPV of MRI for pathologic malignant nipple discharge were respectively 97.7%, 41.1%, 33.6% and 98.3%. Among the 43 cases of breast cancer, 10 cases (23.3%) were occult malignancy with negative ultrasound and mammography and malignant lesions were detected by MRI. The sensitivity, specificity, PPV and NPV of MRI for occult malignancy were 81.8%, 53.7%, 24.4%, and 97.3%.Conclusion:MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge, especially when conventional imaging is negative .

Objective To evaluate the oncological safety of axillary reverse mapping in patients with breast cancer.Methods Patients with sentinel lymph node biopsy(SLNB) or axillary lymphnode dissection (ALND) between Oct 2015 and Feb 2016 were enrolled in this study prospectively.Axillary reverse mapping (ARM) procedure was done using a radioisotope before the surgery.All the ARM nodes were identified and sent separately for histologic analysis.Results 78 patients underwent 78 axillary operations.Of 53 patients with SLNB,33 (62.3％)had ARM nodes identified.22 (41.5％)had the crossover of the ARM nodes with the SLNs,and one (4.5％) had positive ARM node.Of 36 patients with ALND,33 (91.7％) had ARM nodes identified.9(25％)had positive ARM nodes.Positive ARM node status was significantly associated with advanced axillary disease(P =0.036).Conclusion Preserving ARM nodes in SLNB is oncologically safe to reduce upper extremity lymphedema.

Objective To evaluate the long-term safety of sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue in breast cancer patients.Methods 198 breast cancer patients with clinical negative axillary lymph node received sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue.Patients were followed up and regional lymph node recurrence,disease free survival(DFS) and overall survival(OS) were analyzed.Results After a median follow-up of 70 months,2 patients had ipsilateral lymph node recurrence with a regional lymph node recurrence rate of 1％ (2/198).14 patient had recurrence or metastasis and 6 patients died of distant metastasis.The estimated 6 years DFS was 94.4％ and OS was 96.5％.The incidence of arm lymphoedema within patients who received axillary lymph node dissection was 4.5％ and it was 2.5％ in patients who received sentinel lymph node biopsy.Conclusions The sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue was safe and reliable method for further staging axillary lymph node stastus.