To compare the therapeutic effect and adverse effect between the platinum-containing adequate dose chemotherapy and reduced dose chemotherapy combined with elemene in elderly patients with recurrent and metastatic breast cancer.

The 72 elderly patients with recurrent and metastatic breast invasive ductal carcinoma in the First and Second Affiliated Hospitals of Dalian Medical University from December 2009 to June 2015 were involved in a retrospective study. All the cases had complete follow-up data. They were divided into conventional chemotherapy group (n=37) and combined chemotherapy group (n=35). Patients in conventional chemotherapy group were treated with cisplatin 75 mg/m² applied in 2-3 days and gemcitabine 1000 mg/m² or vinorelbine 25 mg/m² applied on days 1 and 8, one cycle every 3 weeks. Patients in combined chemotherapy group were treated with cisplatin 60-75 mg/ m² applied in 2-3 days and gemcitabine 800 mg/m² or vinorelbine 20 mg/m² on days 1 and 8, one cycle every 3 weeks. Patients in combined chemotherapy group were also injected with elemene 400 mg/d, 2 weeks as a course of treatment. The short-term and long-term efficacy, adverse reaction and quality of life in two groups were analyzed. χ² test was used for group comparison and rank sum test was used for rank data comparison. Survival analysis was conducted using Kaplan-Meier and Log-rank methods.

The proportions of patients with complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) were 10.81% (4/37), 37.84% (14/37), 24.32% (9/37) and 27.03 % (10/37) in conventional chemotherapy group, 11.43% (4/35), 34.28% (12/35), 22.86% (8/35) and 31.43% (11/35) in combined chemotherapy group, respectively, indicating no significant difference (Z=-0.289, P=0.773). The incidence of leukopenia in combined chemotherapy group was significantly lower than that in conventional chemotherapy group [45.71%(16/35) vs 70.27%(26/37), Z=-2.025, P=0.043]. Adverse reactions in digestive system were mainly nausea and vomiting, observed in 36 cases (97.30%) of conventional chemotherapy group and 28 cases (80.00%) of combined chemotherapy group, indicating a significant difference (Z=-2.080, P=0.038). There were no significant differences in the incidence of other adverse reaction between conventional chemotherapy group and combined chemotherapy group (thrombocytopenia: 35.14% vs 20.00%, Z=-1.425, P=0.154; anemia: 35.14% vs 37.14%, Z=-0.066, P=0.947; liver function impairment: 29.73% vs 25.71%, Z=-0.265, P=0.791). There was no significant difference in quality of life between two groups (Z=-1.760, P=0.078). The median survival of conventional chemotherapy group and combined chemotherapy group was 8.9 and 6.5 months respectively, indicating no significant difference (χ²=0.226, P=0.634).

For elderly patients with recurrent and metastatic breast cancer, platinum-containing reduced dose chemotherapy combined with elemene has beneficial therapeutic effect similar to adequate dose chemotherapy, with higher safety.

In the department of breast surgery, there are a large number of outpatients who need rapid surgical treatment, such as the patients with breast fibroadenoma, intraductal papilloma with nipple discharge, gynecomastia ofⅠ-Ⅱ degree. Daycare ward is an advanced model for small and medium-sized breast surgery. We adopted the daycare ward system in the Department of Breast Surgery, Southwest Hospital since 2013 to explore the mode of operation and management methods. After 4 years of practice, the daycare ward system has become a key part of clinical management, with the advantages of saving medical resources, reducing the workload, improving the efficiency and increasing patient satisfaction. In this paper, our experiences on the selection of daycare surgery patients, standard of facilities in daycare operating room and daycare ward, personnel administration and training standard, pre-hospital check-up procedures and pathways, and the procedures and management system of daycare surgery were briefly introduced in order to provide a reference to our counterparts.