Surgical adjuvant chemotherapy.Results with one short course with cyclophosphamide after mastectomy for breast cancer

Abstract

One single six-day course with cyclophosphamide (total dose 30 mg/kg) was given immediately after mastectomy to 507 breast cancer patients, with 519 randomized controls receiving no adjuvant chemotherapy. The control group now has 234 recurrences and 196 deaths, and the treatment group 175 recurrences and 146 deaths. The differences of 59 recurrences and 50 deaths in favour of the treatment group are significant with p values less than 0.001 and less than 0.01 respectively. The differences in recurrence rates increased gradually, reached 10.71% four years after mastectomy (p less than 0.001), and remained at the same level for another 6 years. The differences in death rates increased until 6 years after mastectomy, and was 10.48% after 10 years. With this pattern, the mechanism is probably not a delay in onset of clinical recurrences, but a definite reduction of recurrence rates due to tumoricidal chemotherapy. Prognostic factors or menstrual state had apparently no influence on the effect of this type of adjuvant chemotherapy. Side effects were of short duration and very moderate. Since there was a good effect in the prognostically most favourable groups of patients, treatment of such cases seems therefore also justified. The same chemotherapy course given 3 weeks after mastectomy seemed without effect.

West Midlands Oncology Association trials of adjuvant chemotherapy in operable breast cancer: results after a median follow-up of 7 years. I. Patients with involved axillary lymph nodes

“…Analysis showed no significant relationship between ER and relapse-free survival and overall survival whereas there was a significant effect of chemotherapy upon relapse-free survival but not overall survival in patients with PR positive tumours (Table II). This appeared to be mainly in the premenopausal group (Table IV) (Bonadonna et al, 1985) Guys/Manchester CMF + + (PR) Padmanabhan et al, 1986) This supports the association in this study between PR positive tumours and prolonged relapse free survival and is consistent with a partial endocrine effect of chemotherapy.…”

Influence of Timing of Initiation of Adjuvant Chemotherapy Over Survival in Breast Cancer: A Negative Outcome Study by the Spanish Breast Cancer Research Group (GEICAM)

“…Besides, experimental studies suggesting that early chemotherapy after breast tumor resection prevented the accelerated growth of tumor at distant sites [20], the study of Nissen-Meyer (n = 1,026) assessed the benefit of a cycle alone of chemotherapy after breast surgery, and observed an advantage in DFS (52% vs. 40%; P < 0.001), but not in OS (36% vs. 31%, NS) compared to the administration within 2-4 weeks [21]. More recently van der Hage et al [22] have found an advantage on the administration of one-cycle perioperative chemotherapy (within 36 h of surgery) with a regimen of fluorouracil, doxorubicin and cyclophosphamide compared to no adjuvant treatment.…”

Embolization Coils as Tumor Markers for Mammography in Patients Undergoing Neoadjuvant Chemotherapy for Carcinoma

“…In higher risk tumors, adjuvant chemotherapy is used to treat clinically occult micrometastases before they have a chance to disseminate into the rest of the body and mutate into more aggressive cell types. This therapy has proven to be effective in reducing long-term mortality [1][2][3]. Recently, this theory has been expanded: The sooner chemotherapy is instituted, the more vulnerable the cancer cells are likely to be to treatment and, therefore, the more effective the chemotherapy [4].…”