Six-year results of a multimodality treatment strategy for locally advanced breast cancer

Abstract

Between 1976 and 1982, 59 patients with locally advanced breast cancer were treated with preoperative supervoltage radiotherapy, adjuvant preoperative and postoperative hormonochemotherapy, and modified radical mastectomy. Systemic treatment, which was started simultaneously with radiotherapy, consisted of a combination of daily oral tamoxifen and a monthly alternation of Doxorubicin + vincristine and cyclophosphamide + methotrexate + 5-fluorouracil (CMF). One of each cycle was given preoperatively at half dosage and five of each were repeated postoperatively at full dosage. All patients became operable. Results of pathologic examination of the operative specimen, available in 51 patients, showed complete disappearance of tumor tissue in breast areas in eight patients, of which three still had positive axillary nodes. After a median follow-up time of 6 years locoregional failure was observed in 12 patients (20%) but in only three (5%) did it occur before distant failure. The actuarial median survival of the entire patient population is close to 4 years. Seven patients are alive without recurrence at greater than 9 years. This aggressive multidisciplinary treatment approach is associated with a projected 30% long-term survival (10 years), excellent local control, but substantial toxicity.

The management of locally advanced breast cancer

“…Median disease free interval was 46 months and estimated median survival more than 6 years; toxicity from treatment was high. Piccart et al (1988) treated 59 patients with locally advanced breast cancer by combined radiotherapy, tamoxifen and chemotherapy (doxorubicin and vincristine alternating with CMF). All patients became operable and had total mastectomy and axillary clearance after which chemotherapy was resumed for 1 year.…”

“…Only when very large differences are seen against historical controls can we have some certainty that progress has been made; this is not yet the case with the studies of primary chemotherapy reported so far. Undoubtedly, primary chemotherapy achieves a high clinical response rate in locally advanced breast cancer, but residual disease is found in the majority of mastectomy specimens (Israel et al, 1986;Piccart et al, 1988). Nevertheless, despite this inability of chemotherapy reliably to induce pathological complete remission, it does facilitate implementation of radical local treatment.…”

High-dose busulfan, melphalan and thiotepa as consolidation for non-inflammatory high-risk breast cancer

“…The median number of metastatic lymph nodes for patients who received adjuvant chemotherapy after surgery was 11 (range 0-35) and five (range 1-18) for those treated with neoadjuvant chemotherapy prior to surgery. The median time between diagnosis and HDC/ASCI for the entire group was 7 months (range [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

“…[1][2][3][4][5][6][7][8][9] At 5 years, the best reported relapsefree survival for patients with four to nine metastatic lymph nodes is 46-67%; 1 at 10 years, 32-47%. 2 Moreover, the risk of relapse increases with each additional metastatic lymph node found at surgery.…”

“…2 Moreover, the risk of relapse increases with each additional metastatic lymph node found at surgery. Patients with stage II breast cancer who have у10 lymph-nodes containing metastatic disease, [3][4][5][6][7] and stage III disease 8,9 have a probability of disease-free survival (DFS) at 5 years of 13 to 45% which falls to 10 to 30% at 10 years.…”