CMF + radiotherapy in the primary treatment of operable breast cancer: Preliminary results of a phase II pilot study

Abstract

Background and Objectives: Chemotherapy and radiotherapy have been investigated in several studies about their role in primary (neoadjuvant) treatment before surgery in breast cancer. We proposed a pilot study to evaluate a primary scheme of alternate radio‐chemotherapy in the treatment of operable (T2‐ small T3) breast cancer. Methods 14 patients were recruited. Cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) were administered on days 1 and 8, every 4 wk, for two cycles. Radiotherapy was administered during the 3rd and 4th wk (5 d/wk) after the beginning of chemotherapy. The patients were operated on within 2–4 wk. All the patients received four additional cycles of chemotherapy within 1 mo after surgery. Results We observed: 1 (8.3%) complete remission (CR), 8 (66.7%) partial remission (PR), 3 (25%) stationary disease (SD); no progressive disease was observed. Modified radical mastectomy was performed on 7 patients (58.3%). Conservative surgery was performed on 5 cases (41.7%). No major complications were observed. No patient has shown local or distant recurrence. Conclusions This study shows the feasibility of a primary chemo‐radiotherapy treatment for breast cancer. But to evaluate the impact of this therapy on overall survival and recurrence risk and its possible introduction in clinical practice, we need larger series and longer follow‐up. J. Surg. Oncol. 1998;68:48–50. © 1998 Wiley‐Liss, Inc.

Immediate autologous breast reconstruction after neoadjuvant chemoradiotherapy for breast cancer: initial results of the first 29 patients

“…Within this algorithm, the patients are treated with preoperative neoadjuvant chemotherapy and then with radiation before the mastectomy. Numerous reports have shown that this is oncologically safe . The chemotherapy regime is tailored according to tumour markers and biology in the usual fashion and is not altered by this new protocol.…”

“…Numerous reports have shown that this is oncologically safe. [15][16][17][18][19][20][21] The chemotherapy regime is tailored according to tumour markers and biology in the usual fashion and is not altered by this new protocol. The radiotherapy is given as described in Methods section.…”

New treatment sequence protocol to reconstruct locally advanced breast cancer

“…Our group suggests that those who would normally be offered neoadjuvant chemotherapy and adjuvant radiotherapy instead have both treatments in the neoadjuvant setting prior to mastectomy at which immediate free autologous reconstruction (TRAM/DIEP) is also performed. Of the few similar trials published with small numbers of patients with LABC treated by neoadjuvant chemotherapy followed by preoperative radiotherapy, none have included free autologous/perforator flap reconstruction as an end point for assessment . We propose a strategy to evaluate this combined cancer management and reconstructive pathway.…”

“…Attempting to increase breast conservation, some trials have evaluated neoadjuvant chemotherapy followed by preoperative radiotherapy. The rationale is to achieve synergistic cytotoxicity with higher complete pathological response rates . It remains unknown whether pathological responses from chemotherapy alone are similar to those achieved with synchronous and sequential preoperative radiotherapy, but it has been observed that only trials comparing variable treatment sequencing can address this question …”

“…In these trials comparing neoadjuvant chemoradiotherapy to chemotherapy alone, complete clinical remission was achieved in 89%, complete pathological response in 36 versus 5%, partial pathological response in 57 versus 94% and increased median survival and tumour‐free survival . Oncological efficacy of this treatment strategy for LABC is therefore supported and considered safe …”