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Multimodal-Therapy Breast Salvage in the Urban Poor With Locally Advanced Cancer

Multimodal-Therapy Breast Salvage in the Urban Poor With Locally Advanced Cancer Abstract Objectives: To determine whether economically disadvantaged urban women with locally advanced breast cancer (American Joint Committee on Cancer stages IIB to IIIB) have rates of response to sequential neoadjuvant chemotherapy and radiation, breast salvage rates, overall survival rates, and disease-free survival rates comparable with those previously reported in other socioeconomic groups and to compare these variables in different ethnic groups within the study population. Design: Prospective, nonrandomized, case series. Setting: Urban county hospital. Patients: Thirty-seven women with locally advanced breast cancer who came to the breast clinic at Cook County Hospital, Chicago, Ill, during a 3-year interval. Intervention: Sequential chemoradiation followed by surgery in selected patients. Main Outcome Measures: Comparison of clinical response rates, disease-free survival rates, and breast salvage rates between different ethnic groups in the study population. Results: In the entire group, the overall response rate to neoadjuvant chemotherapy was 73%, with a complete response rate of 32%. Twenty-five percent of patients whose tumors responded incompletely to chemotherapy had a complete response after subsequent radiation. With a mean follow-up of 18.7 months, 65% of patients had no evidence of disease, and breast salvage without evidence of recurrent disease was achieved in 38% of patients. No differences in overall response rates, breast salvage rates, or early disease-free survival rates were observed within different ethnic groups in the study population, and these results are generally comparable with previously reported results in other socioeconomic groups. Conclusion: These results do not show significant differences in responses to sequential chemotherapy and irradiation, in breast salvage rates, or in survival between different ethnic groups in this study population.(Arch Surg. 1996;131:424-428) References 1. Hortobagyi GN, Ames FC, Buzdar AU, et al. Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy . Cancer . 1988;62:2507-2516.Crossref 2. Hortobaygi GN, Blumenschein GR, Spanos W, et al. Multimodality treatment of locoregionally advanced breast cancer . Cancer . 1983;51:763-768.Crossref 3. Jacquillat CJ, Weil M, Baillet F, et al. Results of neoadjuvant chemotherapy and radiation in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer . Cancer . 1990;66:119-129.Crossref 4. Heys SD, Eremin JM, Sarkar TK, Hutcheon AW, Ah-See A, Eremin O. Role of multimodality therapy in the management of locally advanced carcinoma of the breast . J Am Coll Surg . 1994;179:493-504. 5. Morrow M, Braverman A, Thelmo W, et al. Multimodality therapy for locally advanced breast cancer . Arch Surg . 1986;121:1291-1296.Crossref 6. Lewison EF, Montague AC, Kuller L. Breast cancer treated at the Johns Hopkins Hospital 1951-56 . Cancer . 1966;19:1359-1364.Crossref 7. Myers MH, Hankey BF. Cancer patient survival in the United States . In: Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention . Philadelphia, Pa: WB Saunders Co; 1982:166-178. 8. Natarajan N, Nemoto T, Mettlin C, Murphy GP. Race-related differences in breast cancer patients: results of the 1982 national survey of breast cancer by the American College of Surgeons . Cancer . 1985;56:1704-1709.Crossref 9. Silverberg E, Pointdexter CE, Garfinkel L. Cancer in black americans . Cancer . 1980;30:39-44. 10. Vernon SW, Tilley BC, Neale AV, Steinfeldt L. Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer . Cancer . 1985;55:1563-1571.Crossref 11. Ownby HE, Frederick J, Russo J, et al. Racial differences in breast cancer patients . J Natl Cancer Inst . 1985;75:55-60. 12. Nemoto TJ, Vana RN, Bedwar HW, et al. Management and survival of female breast cancer: results of the national survey by the American College of Surgeons . Cancer . 1980;45:2917-2924.Crossref 13. Pierce L, Fowbie B, Solin LJ, Schultz DJ, Rosser C, Goodman RL. Conservative surgery and radiation therapy in black women with early stage breast cancer . Cancer . 1992;69:2831-2841.Crossref 14. Kimmick G, Muss HB, Case LD, Stanley V. A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer . Cancer . 1991;67:2850-2854.Crossref 15. White JE, Enterline JP, Alam Z, Moore RM. Cancer among blacks in the United States—recognizing the problem . In: Mettlin C, Murphy GP, eds. Cancer Among Black Populations . New York, NY: Alan R Liss Inc; 1981:33-53. 16. Gregorio D, Cummings M, Michalek A. Delay, stage of disease, and survival among white and black women with breast cancer . Am J Public Health . 1983; 73:590-593.Crossref 17. Gordon NH, Crowe JP, Brumberg J, Berger NA. Socioeconomic factors and race in cancer recurrence and survival . Am J Epidemiol . 1992;135:609-618. 18. Berg JW, Ross R, Latourette HB. Economic status and survival of cancer patients . Cancer . 1977;39:467-477.Crossref 19. Basset MT, Krieger N. Social class and black-white differences in breast cancer survival . Am J Public Health . 1986;76:1400-1403.Crossref 20. McWhorter WP, Mayer WJ. Black/white differences in type of initial breast cancer treatment and implications for survival . Am J Public Health . 1987;77:1515-1517.Crossref 21. Mohla S, Sampson CC, Khan T, et al. Estrogen and progesterone receptors in breast cancer in black americans: correlation of receptor data with tumor differentiation . Cancer . 1982;50:552-559.Crossref 22. Mohia S, Griffith W, Sampson CC, Wilson J, Narang V, Leffall L Jr. Hormone receptors, tumor differentiation, and breast cancer in black Americans . In: Jones LA, ed. Minorities and Cancer . New York, NY: Springer-Verlag; 1989:169-179. 23. Henderson VJ, Organ CH Jr, Soler M. The dubious nature of ethnicity as a risk factor in breast cancer . In: Johnson L, Wise H Jr, eds. Breast Cancer: Controversies in Management . Armonk, NY: Futura Publishing Co Inc; 1994:491-505. 24. Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer: results of the National Cancer Institute black/white cancer survival study . JAMA . 1994;272:947-954.Crossref 25. Cancer in Illinois 1990: An Incidence Report by 111 Hospitals . Chicago, III: American Cancer Society, Illinois Division Inc; 1990. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Multimodal-Therapy Breast Salvage in the Urban Poor With Locally Advanced Cancer

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References (31)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430160082017
Publisher site
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Abstract

Abstract Objectives: To determine whether economically disadvantaged urban women with locally advanced breast cancer (American Joint Committee on Cancer stages IIB to IIIB) have rates of response to sequential neoadjuvant chemotherapy and radiation, breast salvage rates, overall survival rates, and disease-free survival rates comparable with those previously reported in other socioeconomic groups and to compare these variables in different ethnic groups within the study population. Design: Prospective, nonrandomized, case series. Setting: Urban county hospital. Patients: Thirty-seven women with locally advanced breast cancer who came to the breast clinic at Cook County Hospital, Chicago, Ill, during a 3-year interval. Intervention: Sequential chemoradiation followed by surgery in selected patients. Main Outcome Measures: Comparison of clinical response rates, disease-free survival rates, and breast salvage rates between different ethnic groups in the study population. Results: In the entire group, the overall response rate to neoadjuvant chemotherapy was 73%, with a complete response rate of 32%. Twenty-five percent of patients whose tumors responded incompletely to chemotherapy had a complete response after subsequent radiation. With a mean follow-up of 18.7 months, 65% of patients had no evidence of disease, and breast salvage without evidence of recurrent disease was achieved in 38% of patients. No differences in overall response rates, breast salvage rates, or early disease-free survival rates were observed within different ethnic groups in the study population, and these results are generally comparable with previously reported results in other socioeconomic groups. Conclusion: These results do not show significant differences in responses to sequential chemotherapy and irradiation, in breast salvage rates, or in survival between different ethnic groups in this study population.(Arch Surg. 1996;131:424-428) References 1. Hortobagyi GN, Ames FC, Buzdar AU, et al. Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy . Cancer . 1988;62:2507-2516.Crossref 2. Hortobaygi GN, Blumenschein GR, Spanos W, et al. Multimodality treatment of locoregionally advanced breast cancer . Cancer . 1983;51:763-768.Crossref 3. Jacquillat CJ, Weil M, Baillet F, et al. Results of neoadjuvant chemotherapy and radiation in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer . Cancer . 1990;66:119-129.Crossref 4. Heys SD, Eremin JM, Sarkar TK, Hutcheon AW, Ah-See A, Eremin O. Role of multimodality therapy in the management of locally advanced carcinoma of the breast . J Am Coll Surg . 1994;179:493-504. 5. Morrow M, Braverman A, Thelmo W, et al. Multimodality therapy for locally advanced breast cancer . Arch Surg . 1986;121:1291-1296.Crossref 6. Lewison EF, Montague AC, Kuller L. Breast cancer treated at the Johns Hopkins Hospital 1951-56 . Cancer . 1966;19:1359-1364.Crossref 7. Myers MH, Hankey BF. Cancer patient survival in the United States . In: Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention . Philadelphia, Pa: WB Saunders Co; 1982:166-178. 8. Natarajan N, Nemoto T, Mettlin C, Murphy GP. Race-related differences in breast cancer patients: results of the 1982 national survey of breast cancer by the American College of Surgeons . Cancer . 1985;56:1704-1709.Crossref 9. Silverberg E, Pointdexter CE, Garfinkel L. Cancer in black americans . Cancer . 1980;30:39-44. 10. Vernon SW, Tilley BC, Neale AV, Steinfeldt L. Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer . Cancer . 1985;55:1563-1571.Crossref 11. Ownby HE, Frederick J, Russo J, et al. Racial differences in breast cancer patients . J Natl Cancer Inst . 1985;75:55-60. 12. Nemoto TJ, Vana RN, Bedwar HW, et al. Management and survival of female breast cancer: results of the national survey by the American College of Surgeons . Cancer . 1980;45:2917-2924.Crossref 13. Pierce L, Fowbie B, Solin LJ, Schultz DJ, Rosser C, Goodman RL. Conservative surgery and radiation therapy in black women with early stage breast cancer . Cancer . 1992;69:2831-2841.Crossref 14. Kimmick G, Muss HB, Case LD, Stanley V. A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer . Cancer . 1991;67:2850-2854.Crossref 15. White JE, Enterline JP, Alam Z, Moore RM. Cancer among blacks in the United States—recognizing the problem . In: Mettlin C, Murphy GP, eds. Cancer Among Black Populations . New York, NY: Alan R Liss Inc; 1981:33-53. 16. Gregorio D, Cummings M, Michalek A. Delay, stage of disease, and survival among white and black women with breast cancer . Am J Public Health . 1983; 73:590-593.Crossref 17. Gordon NH, Crowe JP, Brumberg J, Berger NA. Socioeconomic factors and race in cancer recurrence and survival . Am J Epidemiol . 1992;135:609-618. 18. Berg JW, Ross R, Latourette HB. Economic status and survival of cancer patients . Cancer . 1977;39:467-477.Crossref 19. Basset MT, Krieger N. Social class and black-white differences in breast cancer survival . Am J Public Health . 1986;76:1400-1403.Crossref 20. McWhorter WP, Mayer WJ. Black/white differences in type of initial breast cancer treatment and implications for survival . Am J Public Health . 1987;77:1515-1517.Crossref 21. Mohla S, Sampson CC, Khan T, et al. Estrogen and progesterone receptors in breast cancer in black americans: correlation of receptor data with tumor differentiation . Cancer . 1982;50:552-559.Crossref 22. Mohia S, Griffith W, Sampson CC, Wilson J, Narang V, Leffall L Jr. Hormone receptors, tumor differentiation, and breast cancer in black Americans . In: Jones LA, ed. Minorities and Cancer . New York, NY: Springer-Verlag; 1989:169-179. 23. Henderson VJ, Organ CH Jr, Soler M. The dubious nature of ethnicity as a risk factor in breast cancer . In: Johnson L, Wise H Jr, eds. Breast Cancer: Controversies in Management . Armonk, NY: Futura Publishing Co Inc; 1994:491-505. 24. Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer: results of the National Cancer Institute black/white cancer survival study . JAMA . 1994;272:947-954.Crossref 25. Cancer in Illinois 1990: An Incidence Report by 111 Hospitals . Chicago, III: American Cancer Society, Illinois Division Inc; 1990.

Journal

Archives of Surgery – American Medical Association

Published: Apr 1, 1996

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