Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy

Abstract

One hundred seventy-four evaluable patients with noninflammatory Stage III (both operable and inoperable) breast cancer were treated with a combined modality strategy between 1974 and 1985. All patients received combination chemotherapy with 5-fluorouracil, Adriamycin (doxorubicin), and cyclophosphamide (FAC) as their initial form of therapy. After three cycles of chemotherapy, local treatment in the form of a total mastectomy with axillary dissection, or radiotherapy, or both, was completed. Subsequently, adjuvant chemotherapy was continued. There were 48 patients with Stage IIIA, and 126 patients with Stage IIIB disease. A complete remission was achieved in 16.7% of the patients, and 70.7% achieved a partial remission after the initial three cycles of FAC. The complete response rate was higher for patients with Stage IIIA, than for patients with Stage IIIB disease. All but six of the 174 patients treated were rendered disease-free after induction chemotherapy and local treatment. The median follow-up of this group of patients is 59 months. The 5-year disease-free survival rates were 84% for patients with Stage IIIA, and 33% for patients with Stage IIIB disease. The 5-year survival rate for, patients with Stage IIIA was 84%, and for patients with Stage IIIB 44%. At 10 years, 56% of patients with Stage IIIA and 26% of patients with Stage IIIB disease are projected to be alive. Younger patients, and those with estrogen receptor-positive tumors, had a trend for better survival than older patients and those with estrogen receptor-negative tumors. The quality of response to induction chemotherapy correlated prominently with prognosis, as did compliance with treatment. Twenty-six patients (15.3%) had locoregional recurrence. This multidisciplinary approach to locally advanced breast cancer rendered most patients disease-free and produced an excellent local control rate. Modifications of this treatment strategy may result in further improvement of survival rates.

Primary systemic therapy for operable breast cancer

“…patients with ER-poor or ER-negative tumours). The proportion of such patients with tumours which were chemosensitive was high and lies within the observed range of 70-93% described with 'neoadjuvant' chemotherapy in more locally advanced breast cancers (Jacquillat et al, 1988;Hortobagyi et al, 1988;Swain et al, 1987). Of those individual tumours directly demonstrated as endocrine-resistant however the proportion of ER-poor/ negative tumours regressing with chemotherapy paralleled that of primary chemotherapy (-80%) In addition to the benefit of selecting appropriate systemic therapy, there is theoretical (Goldie & Coldman, 1979;Skipper 1964), experimental (Fisher et al, 1983) and clinical (Nissen-Meyer et al, 1986;Ragaz, 1986) …”

Disease-free survival in patients with non-metastatic breast cancer

“…11,[27][28][29] A survey of women with stage III breast cancer subject to the same kind of treatment showed a difference in DFS at 5 years between stage IIIA (84%) and IIIB (33%) patients. 30 In a study that compiled data from the EUROCARE and SEER trials, the risk of death was shown to increase alongside staging (T2-3N0M0: risk of 4.87; T1-3NM0: risk of 10.44; T4M0: risk of 17.22; all in relation to T1N0M0). 31 Allemani et al noted relative survival estimates of 89% for patients with tumors confined to the breast and 62% for tumors with lymph node involvement.…”

Trastuzumab signaling in ErbB2-overexpressing inflammatory breast cancer correlates with X-linked inhibitor of apoptosis protein expression

“…9). Even with neoadjuvant and multimodality treatment, disease-free survival is still poor (10,11) and there is an unmet clinical need for new therapeutic strategies.…”