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The pathologic changes associated to response to primary chemotherapy in a series of 303 operable breast cancers are evaluated and correlated to patients' follow-up (interval free of disease and survival). In our series, the incidence of microscopic changes related to chemotherapy is 43.9%. Tumor replacement by loose fibrosis is the most common pathologic event. In most cases, the intensity of fibrotic change is proportional to the degree of clinical-mammographic reduction of the tumor mass. However, some discrepancies exist in the sense of absence of microscopic changes in cases of well-documented mammographic reduction as well as in cases without clinical reduction but with large areas of chemotherapy-related fibrosis. The presence of pathologic response is significantly associated with better survival rate.

Cyropreservation of blood vessels has been carried out for some decades with variable results. A rabbit model was used to compare cryopreserved femoral artery allografts (n = 12 arteries), fresh autografts (n = 15 arteries), and fresh allografts (n = 16 arteries) at 1 and 3 months postoperatively. Patency rates were highest in the fresh autografts (86.7 percent), followed by the cryopreserved allografts (66.7 percent at 1 month and 83.3 percent at 3 months) and fresh allografts (62.5 percent at 1 month and 75 percent at 3 months). The fresh allografts showed the greatest alterations in endothelial cells and intima and muscle layer, followed by cryopreserved allografts, and then fresh autografts. Changes observed included pseudoendothelium formation, thickened intima, and thinner muscle layer. Cellular infiltrate appeared on the vessel walls only in the cryopreserved allografts (25 percent), but this did not have an effect on vascular patency. Fresh autografts remain the graft of choice for vascular defects, but cryopreserved allografts serve as the most appropriate option when the former are unavailable.

BACKGROUND Primary chemotherapy (PC) is becoming an accepted practice to treat large tumors to avoid mastectomies and as a surrogate of outcome. METHODS A series of 305 patients with tumors > 3 cm with T2–3N0–1M0 classification were treated with a multimodal approach that consisted of 3 courses of primary cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) followed by appropriate local treatment and 3 more courses of CMF or 4 courses of doxorubicin. Response was assessed by mammography. RESULTS The overall response rate was 48% (a 3% pathologic complete response rate). Conservative surgery was achieved in 79.64% of the patients with a low rate of local disease recurrences (5%). Toxicity was minimal. With a median follow‐up of 104 months, the 8‐year disease‐free survival (DFS) rate was 57.63% and the 8‐year overall survival (OS) was 67.65%. The DFS and OS rates for patients with a clinical response were significantly longer, i.e., 70% (P = 0.0048) and 90% (P = 0.0042), respectively. CONCLUSIONS PC with CMF was feasible. A high rate of breast‐conservative surgery was achieved. The current results stressed the value of PC to increase conservative surgery and as a predictor of outcome. Cancer 2005. © 2005 American Cancer Society.