The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery

• Published in: World journal of surgery 1985-10, Vol.9 (5), p.775-785
• Main Authors: Sorace, Richard A., Bagley, Caroline S., Lichter, Allen S., Danforth, David N., Wesley, Margaret W., Young, Robert C., Lippman, Marc E.
• Format: Article
• Language: English
• Subjects: Advanced Breast Cancer; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Estrogens, Conjugated (USP) - administration & dosage; Female; Fluorouracil - administration & dosage; Humans; Leucovorin; Leucovorin - administration & dosage; Mese; Methotrexate - administration & dosage; Middle Aged; Neoplasm Staging; Radiography; Random Allocation; Stage IIIB; Tamoxifen; Tamoxifen - administration & dosage
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF01655193

Forty‐three patients with locally advanced breast cancer, 15 with stage IIIA and 28 with stage IIIB, received primary induction chemotherapy, including hormonal synchronization in 38 patients, to a maximum objective clinical response before proceeding to local therapy. Patients achieving a pathological complete response received radiation therapy, while patients with residual disease, partial response (PR), or no change (NC) status received debulking surgery prior to radiation therapy; in all patients, 6 additional months of chemotherapy were administered. Chemotherapy consisted of cyclophosphamide 500 mg/m2 and doxorubicin 30 mg/m2 intravenously day 1; tamoxifen 40 mg/m2 orally days 2–6; premarin 0.625 mg orally every 12 hours 3 times beginning on day 7; methotrexate (mtx) 300 mg/m2 intravenously followed in 1 hour by 5‐fluorouracil 500 mg/m2 intravenously day 8, and leucovorin 10 mg/m2 orally every 6 hours 6 times beginning 24 hours after mtx. Forty‐two patients are evaluable with respect to response, time to progression, and survival. Objective response rate to chemotherapy was 90% with 50% CR, 40% PR, and 10% NC. Median number of cycles of chemotherapy to achieve a CR, PR, or NC was 5, 4, and 4 respectively. Eighteen patients with a CR to chemotherapy were assessed by multiple biopsies (16 patients) or mastectomy (2 patients). Fourteen patients (70%) were proven to be pathological complete responders. Thirty patients have completed combined therapy thus far and all have been rendered disease free. Seven stage IIIB patients have relapsed, 6 of them having inflammatory histological findings. No stage IIIA patients have relapsed. Median survival and time to progression have not been reached for either stage. Résumé Quarante‐trois malades qui présentaient un cancer du sein avancé (15 répondant au stade IIIA et 28 au stade IIIB) ont été traitées par chimiothérapie et chez 38 d'entre elles par hormonothérapie associée pour obtenir une involution tumorale avant de procéder au traitement local. Lorsque la réponse à ce traitement fut complété (CR) la radiothérapie fut associée à la chimiothérapie. Quand la réponse fut incomplète (PR = réponse partielle) ou négative (NC = pas de changement) l'intervention chirurgicale fut pratiquée et suivie d'une irradiation locale. Chez toutes les malades la chimiothérapie fut ensuite poursuivie pendant 6 mois. La chimiothérapie consista en l'administration de cyclophosphamide 500 mg/m2; de doxorubicine 30 mg/m2 I.V. au jour 1