title: [Impact of preoperative lymphatic chemotherapy on relapse and metastasis of breast cancer and its mechanism].
abstract: OBJECTIVE
  Although it is reported that lymphatic chemotherapy could raise drug concentrations in local lymph nodes and prolong survival time of patients with gastrointestinal tumors, its effect on breast cancer has not been explored. This study was to explore the impact of lymphatic chemotherapy on relapse and metastasis of breast cancer, and to investigate the mechanism.
  
  
  METHODS
  Sixty patients with breast cancer of stage II-III were randomized into 2 groups: 40 patients in Epi-CH (carbon activated absorbing epirubicin) group were injected with 10 mg of Epi-CH in the tissue around primary tumor 72 h before modified radical resection; 20 patients in control group were injected with 10 mg of aqueous epirubicin in the same region. The stained nodes full of tumor cells in Epi-CH group and non-stained nodes in control group were selected. The apoptotic index (AI) of cancer cells in metastatic axillary lymph node was calculated by TUNEL method; the expression of Fas/Fas-L proteins was examined by SP immunohistochemistry; the relapse and metastatic rate was compared.
  
  
  RESULTS
  The AI of cancer cells in metastatic axillary lymph node was significantly higher in Epi-CH group than in control group [(9.5+/-2.7)% vs. (3.8+/-1.4)%, P<0.01]. The expression of Fas protein was significantly higher in Epi-CH group than in control group (P<0.05), but the expression of Fas-L protein had no difference between the 2 groups (P>0.05). No chemotherapy-related local and whole body reaction occurred in both groups. The relapse and metastatic rate was significantly lower in Epi-CH group than in control group (P<0.05).
  
  
  CONCLUSIONS
  Preoperative Epi-CH lymphatic chemotherapy could suppress relapse and metastasis of breast cancer, which might through up-regulating expression of Fas protein and inducing apoptosis of axillary metastasis cells.
authors.affiliation: Department of Gastrointestinal & Glands Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, P. R. China.
authors.forename: Wu-Jun
authors.initials: WJ
authors.lastname: Wu
authors.forename: Jian
authors.initials: J
authors.lastname: Zeng
authors.forename: Yun-Fei
authors.initials: YF
authors.lastname: Lu
authors.forename: Wei-Zhe
authors.initials: WZ
authors.lastname: Jiang
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.forename: Cheng-En
authors.initials: CE
authors.lastname: Pan
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D017209:Apoptosis / Q000187:drug effects; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D015251:Epirubicin / Q000008:administration & dosage / Q000627:therapeutic use*; D053222:Fas Ligand Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007272:Injections, Intralymphatic; D008198:Lymph Nodes / Q000187:drug effects* / Q000378:metabolism; D008207:Lymphatic Metastasis; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011300:Preoperative Care; D016037:Single-Blind Method; D019014:fas Receptor / Q000378:metabolism
chemical_list: D000903:Antibiotics, Antineoplastic; D053222:Fas Ligand Protein; D019014:fas Receptor; D015251:Epirubicin