Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breast

Abstract

Background. Few women with locally advanced breast cancer remain disease‐free, even for 2 years. Response to induction chemotherapy may be associated with longer disease‐free and overall survival rates. The role of breast conservation in selected patients with response to induction chemotherapy was evaluated. Methods. Since 1979, patients with Stages IIB and III breast cancer have undergone induction chemotherapy; patients with response continued chemotherapy until a plateau of regression was achieved. Before 1983, all patients having a response to chemotherapy underwent mastectomy; since 1983, selected patients have undergone breast conservation. Outcomes were tallied comparing these two groups of patients. Results. The study group included 189 women, who were followed up for 12–159 months (median, 46 months) after diagnosis. Of the patients, 85% had a response to induction chemotherapy. Patients with no response were excluded from additional consideration in this study. One hundred three (64%) women underwent mastectomy; 55 (36%) were treated with breast conservation. The disease‐free 5‐year survival rate was 61% for all patients with a response to chemotherapy; 56% for those having mastectomy and 77% for those having breast conservation. The overall 5‐year survival rate was 69% for all patients with a response to chemotherapy, 67% for those undergoing mastectomy and 80% for those having breast conservation. Conclusions. Induction chemotherapy achieves significant tumor regression in most women with locally advanced breast cancer, permitting subsequent breast conservation or mastectomy with a greater expectation of long‐term success. Breast conservation is used more frequently with the same expectation of success as mastectomy, presuming careful selection based on response to chemotherapy.

Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor‐positive breast cancer

“…Clinical data support the hypothesis that the chemotherapeutic sensitivity of primary tumors and micrometastases is similar. 1,29,30 Therefore, failure of preoperative systemic treatment may be predictive of the response to the same therapy administered postoperatively.…”

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

“…A pCR in the breast and axilla can be obtained in up to 33% of the cases, as a function of treatment used, in operable breast cancer (Hortobagyi et al, 1983;Lippman et al, 1986;Scholl et al, 1994;Schwartz et al, 1994;Powles et al, 1995;Brain et al, 1997;Bonadonna et al, 1998;Fisher et al, 1998;Morrell et al, 1998;Kuerer et al, 1999). It is known that neoadjuvant chemotherapy is able to convert clinically involved lymph nodes to a pathologically negative status in 25 -38% of breast tumours.…”

“…Only a few papers have been published concerning the incidence and outcome of patients with a pCR in the primary tumour and axillary lymph nodes after neoadjuvant chemotherapy (Machiavelli et al, 1998;Kuerer et al, 1999). Most of the literature concerning pCR rates after induction treatment refers to and reports on pCRs in the primary tumour alone (Schwartz et al, 1994;Morrell et al, 1998;Bonadonna et al, 1998). In the National Surgical Adjuvant Breast and Bowel Project B-18 trial (Fisher et al, 1997(Fisher et al, , 1998, 13 (7%) of the 185 operable patients with clinically positive axillary lymph nodes treated with neoadjuvant chemotherapy were found to have no residual invasive tumour in the breast and axillary tissue upon pathological examination.…”

Study on the role of primary systemic chemotherapy with anthracycline combination schedule in locally advanced breast cancer: long term follow up data

“…But approximately 10-20% of patients get complete clinical response and 50-60% achieves a partial response. [24][25][26][27][28][29][30] Thus it proves beyond doubt the role of Anthracycline combination schedule in Indian women in tumour response.…”