A pilot evaluation of alternating preoperative chemotherapy in the management of patients with locoregionally advanced breast carcinoma

• Published in: Cancer 1996-06, Vol.77 (12), p.2520-2528
• Main Authors: Pisansky, Thomas M., Loprinzi, Charles L., Cha, Stephen S., Fitzgibbons, Robert J., Grant, Clive S., Hass, A. Curtis, Reuter, Nicholas F., Wold, Lester E., Ingle, James N., Kardinal, Carl G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; breast neoplasms; Breast Neoplasms - drug therapy; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Carcinoma - drug therapy; Carcinoma - radiotherapy; Carcinoma - surgery; chemotherapy; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease-Free Survival; Female; Humans; mastectomy; Medical sciences; Middle Aged; neoplasm recurrence; Neoplasm Recurrence, Local; pathology; Pharmacology. Drug treatments; Pilot Projects; prognosis; Prospective Studies; radiotherapy; Survival Analysis; survival rate
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19960615)77:12<2520::AID-CNCR15>3.0.CO;2-U

BACKGROUND This prospective trialiu was conducted to evaluate the outcome of patients treated with preoperative and postoperative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma. METHODS Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5‐fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor‐positive tumors, was used after mastectomy. Postoperative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence. RESULTS Although 5 patients (7%) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65%). Sixty‐eight patients (96%) underwent mastectomy. With a median follow‐up of 52 months, the relapse‐free and overall survival rates at 5 years were 42% and 57%, respectively. Locoregional tumor recurrence occurred in 14 patients (20%), and 28 patients (39%) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome. CONCLUSIONS Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse‐free and overall survival estimates for the approach described herein compared favorably with other contemporary reports for this condition. Cancer 1996;77:2520‐8.