Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm

Abstract

Background. The traditional surgical treatment for operable breast carcinoma larger than 3 cm is mastectomy. To avoid mutilating surgery, the authors administered primary chemotherapy to 158 patients with operable nonmetastatic large breast carcinoma with a TNM classification of T2 greater than 3 cm and T3 with a lymph node status of NO‐N1. Conservative treatment was proposed for patients responding to the chemotherapy and whose tumor was reduced to 3 cm or less. The purpose of the study was to evaluate the feasibility and treatment results of this strategy. Methods. The mean patient age was 50.4 years. Eighty‐two patients had T2 carcinomas greater than 3 cm, and 76 had T3 carcinoma. Fifty‐four tumors were classified as lymph node status N0, and 104 as N1. Mean tumor size was 5.6 cm. Patients were treated with three courses of the NVCF regimen (mitoxantrone, vindesin, cyclophosphamide, and 5‐fluorouracil) or the EVCF regimen, in which mitoxantrone was replaced by epirubicin every 4 weeks, and then administered with a radiosurgical combination. Results. The overall response rate to induction chemotherapy was 60.8% with 20.2% complete tumor regression. Twenty‐one percent of the patients experienced grade 3 or 4 chemotherapy toxic effects, which were all acceptable and reversible. Breast‐conserving treatment was feasible in 48.7% of patients (77 of 158). Forty‐five patients (28.5%) were treated with a radiosurgical combination (tumorectomy plus radiation therapy), whereas 32 (20.2%) were treated with radiotherapy alone (external irradiation and brachytherapy). Other patients were treated with mastectomy. Age, tumor stage, histology, hormonal status, and hormonal receptor rate had no influence on the frequency of the observed regressions. Isolated recurrences occurred in 11 patients, 6 who were treated conservatively and 5 who were treated with mastectomy. Metastatic relapses were observed in 38 patients (14.6% in the chemotherapy responders and 38.7% in the nonresponders) (P < 0.02). Five‐year actuarial survival was 73.2% and was significantly higher for responders to the induction treatment. Conclusion. These preliminary results suggest that primary chemotherapy and radiosurgical breast‐conserving treatment is feasible and is an alternative to mastectomy for patients with large operable breast carcinoma who are responders to the induction treatment. The long term benefit of this strategy must be evaluated in well designed controlled trials.

Primary chemotherapy in breast invasive carcinoma: predictive value of the immunohistochemical detection of hormonal receptors, p53, c-erbB-2, MiB1, pS2 and GST pi

“…Predictive value of 'tumour response' Neither tumour response to primary chemotherapy nor local treatment were correlated with subsequent patient outcome in our series, in contrast to other reports (Feldman et al, 1986;Jacquillat et al, 1990;Scholl et al, 1991;Calais et al, 1994). Ideally, tumour regression should have been confirmed by microscopic analysis, but this was impossible, because of the construction of our clinical trial.…”

“…Since 1990 several reports have shown the effectiveness of primary chemotherapy in breast conservative surgery of resectable tumours larger than 3 cm (Bonnadonna et al, 1990;Gazet et al, 1991;Mauriac et al, 1991;Belembaogo et al, 1992;Calais et al, 1994;Smith et al, 1995). This new therapeutic strategy, as well as those used in locally advanced breast disease, requires the validation of clinical and biological factors capable of predicting the tumoral response to cytotoxic therapy, and the subsequent clinical outcome.…”

Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breast-conservation rate

“…Breast-conservation therapy can be performed in 450% of all cases, despite a nonnegligible rate of local recurrences (23.1 vs 8.7% for patients treated by adjuvant chemotherapy), without compromising patients' outcome (Mauriac et al, 1991). The quality of patients' response to this strategy, which is usually followed by locoregional therapy (surgery and/or radiotherapy), seems to be a prognostic factor in many studies (Scholl et al, 1991;Calais et al, 1994;Bonadonna et al, 1998;Brenin and Morrow, 1998;Ferriere et al, 1998). This has become a common approach for the treatment of a variety of neoplasms, including oesophageal, testicular, lung and breast cancers, osteosarcoma and squamous cell cancers of the head and neck.…”

Response to neoadjuvant chemotherapy in operable breast carcinoma and conversion of modified radical mastectomy to breast conservation surgery, long term results: an Indian perspective

“…an overall response rate of 98% and a cCR of 66% was observed following administration of infusional neoadjuvant chemotherapy. 11 An overall objective response rate of 49% with a cCR, cPR, cS and cP of 6.6%, 42.3%, 39.7% and 1.4% respectively was observed in the study by Jose A et al while it was 60.8% with a cCR, cPR, cS and cP of 20.2%, 40.6%, 37.9% and 1.3% respectively in the series of Calais G et al 12,13 An overall response rate of 88% to preoperative chemotherapy in operable breast cancer was reported by Cholet P et al in his study of 50 patients from 1991-1996. The cCR, cPR and cS were 51%, 37% and 12% respectively.…”