Aggressive Combined Moddality in Inflammatory Breast Carcinoma with Minimal Distant Metastasis-A Case Report

發炎性乳癌合併近端皮膚轉移之多重療法－病例報告

陳俊偉(Robert Tan) ； 楊友華(Andrew Young) ； 吳敬堂(Ching-Tang Wu)

《放射治療與腫瘤學》 4卷1期 (1997/03) Pp. 71-76

https://doi.org/10.6316/TRO/199704(1)71

摘要

目的：探討一例T4NIMO發炎性乳癌使用癌症多重療法的效果。
材料與方法：1996年8月，一例42歲停經前的婦女因左側乳房有一塊大而且痛的腫瘤就診．經過檢察後，硬塊大概有12公分×17公分大小。外觀上胸壁有很嚴重的被侵犯合併發炎的現象並侵犯同側的肚皮。同側之腋下淋巴也有腫大。按照病情需要，我們先使用2次的化學治療，藥物含：Cyclopho-sphamide 600 mg，Epirubicin 60 mg，及5-fluorouracil 600 mg（每次給予1天，每4週給予1次。放射治療於第2次化療後2個禮拜使用。放射治療範圍含左側乳房、鎖骨上及腋下淋巴及內側乳房淋巴腺，手術前給予的劑量是 4,000 cGy。在放射治療當中，病人再次接受化療.病人於放射治療後2週接受乳房切除及腋下淋巴切除後術。
結果：第二次化療後，腫瘤大致消了30%。放射治療後，殘餘腫瘤只剩下15%。整個治療過程順利，但病人在第3次化療時因免疫力不足倒致帶狀皰疹的副作用產生。因此病人被迫休息14天。帶狀皰疹痊癒後，病人就接受手術。手術後病理報告顯示沒有殘餘的腫瘤而且也沒有淋巴轉移的跡象。
結論：在本文有限的經驗下可顯示出癌症多重療法對此病人之效果及幫助。

關鍵字

發炎性乳癌 ； 多重療法 ； 放射治療 ； 化學治療

並列摘要

Purpose: To report on the effect of using combined chemotherapy, irradiation and surgery in treating a case of T4N1M1 inflammatory breast carcinoma.
Materials and Methods: In August, 1996, a 42 year old premenopausal woman sought consultation because of a huge, painful ulcerating mass at the left breast. On examination, the tumor measured about 12 cm×17cm in diameter with massive chest wall infiltration and inflammatory changes. Skip lesions were also noted in the ipsilateral abdominal wall. Two courses of chemotherapy using Cyclophosphamide 600 mg, Epirubicin 60 mg and 5-finorouracil 600 mg (Day 1) were given initially. Radiotherapy was started 2 weeks after the second course of chemotherapy. Preoperative dose of 4,000 cGy was given to the left breast, ipsilateral axillary lymph node and internal mammary chain. The third course of chemotherapy was given coneurrently at the time of radiotherapy. Modified radical mastectomy was performed two weeks after radiotherapy.
Results: Tumor regression of 30% of the tumor volume was noted 2 weeks after the second course of chemotherapy. After 4,000 cGy of radiotherapy, the tumor further regressed to only 15% of the original tumor volume. The whole course of treatment was quite smooth, however patient developed herpes zoster in the contralateral chest wall during her third course of chemotherapy. Because of herpes zoster, patient was forced to rest and modified radical mastectomy was performed 2 weeks after radiotherapy. Postoperative pathological report showed no evidence of residual tumor nor evidence of axillary lymph node metastasis.
Conclusion: In our limited experience, the use of combined modality seemed to have provided excellent result to this patient locoregionally as shown in the postoperative pathology report.

並列關鍵字

Inflammatory breast cancer ； Combined modality ； Chemotherapy ； Radiotherapy