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

Morrison, J. M.; Howell, Anthony; Kelly, K.; Grieve, Robert; Monypenny, I.; Walker, R. A.; Waterhouse, J.A.H.

doi:10.1038/bjc.1989.389

Cited by 28 publications

(6 citation statements)

References 20 publications

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“…Since this study was commenced, three randomized trials comparing pre-and post-operative chemotherapy have reported survival data: one study found an initial clear X2 4.690,P'< 0.05 survival advantage, later lost, for preoperative systemic therapy (Scholl et al, 1994(Scholl et al, , 1995; another study reported only a diseasefree survival advantage for the preoperatively treated group (Semiglazov et al, 1994); and the third study did find a survival advantage, but 23% of those in the control arn received no systemic adjuvant therapy and these patients constituted 10% of the relapses (Mauriac et al, 1991). Comparison of our data with historical controls of post-operative adjuvant chemotherapy is unreliable but does not suggest that the women have fared worse than patients treated either with (Morrison et al, 1989;Tormey et al, 1992) or without a doxorubicin based regimen (Fisher et al, 1969).…”

Section: Response To Primary Hormone Therapymentioning

confidence: 51%

Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

Cameron

Anderson²,

Levack³

et al. 1997

Br J Cancer

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Summary Between 1984 and 1990, 94 women presenting to the Edinburgh Breast Unit with operable breast cancer of 4 cm or greater in diameter (T2, T3, NO, Ni, MO) were given preoperative systemic therapy. Initially, all women received hormone therapy, with CHOP (cyclophosphamide 1 g m-2, doxorubicin 50 mg m-2, vincristine 1.4 mg m-2 to a maximum of 2 mg and prednisolone 40 mg per day orally for 5 days) chemotherapy being administered to those who failed to respond by 3 months. After April 1987, first-line hormone therapy was only offered to women with oestrogen receptor (ER)-moderate/-rich (> 20 fmol mg-1 protein) tumours, and CHOP was reserved for those women whose tumours failed to respond to hormone therapy and for those with ER-negative/-poor tumours. Response data have been published previously (Anderson et al, 1991). After a median follow-up of 7.5 years, there is no difference in survival between those women given initial hormone therapy and those given chemotherapy, with neither group having yet reached its median survival. The two key factors that predicted for a poor survival were the number of involved axillary nodes after preoperative systemic therapy (P < 0.00001) and a lack of response to preoperative therapy (P < 0.05). These data suggest that many women with ER-moderate/-rich tumours will have a good prognosis after preoperative hormone therapy alone. However, it is possible to identify, by their post-systemic therapy axillary node status, a group of women who still have an appalling prognosis after preoperative chemotherapy or hormone therapy.

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Section: Response To Primary Hormone Therapymentioning

confidence: 51%

Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

Cameron

Anderson²,

Levack³

et al. 1997

Br J Cancer

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“…Some have shown substantial proportional reductions in such failure rates, one third to one half lower than the incidence in the control arms (4,7,9,10). Others have shown little to no reduction (5,8,31). Tamoxifen has been shown to improve local-regional recurrence rates when used for treatment of estrogen receptor (ER)-positive disease (6,30).…”

mentioning

confidence: 96%

“…In series with median lengths of follow-up of 5 years or longer, local-regional failure occurs at the first site of failure in approximately 15%-20% of node-negative (1)(2)(3)(4)(5) and 25%-40% of node-positive patients (1,(6)(7)(8)(9)(10) with early-stage breast cancer who do not receive systemic therapy. Tumor size (11)(12)(13)(14)(15)(16)(17), the number of positive lymph nodes (11,(14)(15)(16), lymphvascular space invasion (12,17), tumor grade (13,14,17), the distance of tumor from the pectoralis fascia (13,18) or involvement of the fascia and skin (19) can influence the likelihood of such recurrences.…”

mentioning

confidence: 99%

ACR Appropriateness Criteria® on Postmastectomy Radiotherapy

Taylor

Haffty²,

Rabinovitch

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

113

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“…A few controlled studies have also evaluated the impact of dox or dox combination therapy on prognosis (Fisher et al, 1990;Fisher et al, 1989;Grohn et al, 1984;Morrison et al, 1989;Perloff et al, 1986 (Fisher et al, 1989). Dox contributed significantly to the efficacy of adjuvant treatment in terms of disease-free and overall survival in the patients untreated with tamoxifen, while no effect of the addition of dox could be seen in tamoxifen treated patients (Fisher et al, 1989).…”

Section: Efficacymentioning

confidence: 99%

“…Several retrospective as well as controlled trials have, however, demonstrated the feasibility and low long-term toxicity of dox containing adjuvant chemotherapy (Buzdar et al, 1989;Fisher et al, 1990;Fisher et al, 1989;Grohn et al, 1984;Morrison et al, 1989;Perloff et al, 1986;Wendt et al, 1979). In one controlled trial by the NSABP group dox was found to improve prognosis when added to melphalan fluorouracil adjuvant treatment in tamoxifen-nonresponsive patients, while no effect of dox was found when added to the same regimen plus tamoxifen in tamoxifenresponsive patients (Fisher et al, 1989).…”

mentioning

confidence: 99%

The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicin-ftorafur) and tamoxifen in stage II breast cancer. Long-term follow-up results of a randomised trial

Blomqvist

Tiusanen²,

Elomaa³

et al. 1992

Br J Cancer

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Summary Two hundred patients with node positive stage II breast cancer were randomised to four groups after radical mastectomy and axillary evacuation: (1) Postoperative radiotherapy, (2) Adjuvant chemotherapy with eight courses of CAFt (cyclophosphamide 500 mg m-2 + doxorubicin 40 mg/m-2 + ftorafur 20 mg kg-' orally day 1-14) every fourth week, (3) Postoperative radiotherapy and adjuvant chemotherapy and (4) postoperative radiation, adjuvant chemotherapy and tamoxifen 40 mg daily for 2 years.Thirty-two per cent of the patients discontinued treatment due to GI-toxicity, while 26% required dose reductions due to leukopenia. Radiation pneumonitis was more frequent after the combination of postoperative radiotherapy with chemotherapy. There was a better relapse-free survival in the groups receiving chemotherapy compared to radiotherapy alone (P = 0.05), which was highly significant in a multivariate Cox analysis (P = 0.004). No significant survival differences were seen. Tamoxifen had no clear overall effect but there were better relapse-free (P = 0.04) and overall (P = 0.004) survival with tamoxifen in estrogen receptor positive patients, while estrogen receptor negative patients had a somewhat poorer survival (P = 0.07) after tamoxifen.Local control was better (NS) after the combination (93%) radiotherapy and chemotherapy compared to either treatment alone (76% with radiotherapy and 74% with chemotherapy at 5 years).

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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

Cited by 28 publications

References 20 publications

Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

ACR Appropriateness Criteria® on Postmastectomy Radiotherapy

The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicin-ftorafur) and tamoxifen in stage II breast cancer. Long-term follow-up results of a randomised trial

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