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Mastectomy as an Adjuvant to Chemotherapy for Locally Advanced or Metastatic Breast Cancer

Mastectomy as an Adjuvant to Chemotherapy for Locally Advanced or Metastatic Breast Cancer Abstract • Patients with unresectable tumors require local treatment of ulcerating or fungating masses. Chemotherapy can shrink the tumor, permitting mastectomy. Continued chemotherapy treats the overt or micrometastases. Of 27 patients with bulky primary tumors, 15 had overt metastases and 12 did not. Thirteen of the 27 had inflammatory carcinoma. After three to four chemotherapy courses, 24 patients were operable, and 22 underwent mastectomy. Eighteen of the 22 had closure without skin grafts. In three, disease recurred at the primary site, and in five at both primary and distal sites. Preoperatively, one patient (4%) achieved complete response and 19 (70%) achieved partial response. After mastectomy, five patients with metastases in stable partial response further responded to chemotherapy and achieved complete response. Chemotherapy with adjuvant mastectomy is technically feasible and offers the possibility of improved duration of survival in some patients. (Arch Surg 1982;117:882-887) References 1. McLelland R: Mammography in the detection, diagnosis and management of carcinoma of the breast . Surg Gynecol Obstet 1978;146:735-740. 2. Fisher B: Surgery of primary breast cancer , in McGuire WL (ed): Breast Cancer: Advances in Research and Treatment . New York, Plenum Medical Book Co, 1977, vol 1, pp 1-37. 3. Cutler SJ: Classification of extent of disease in breast cancer . Semin Oncol 1974;1:91-96. 4. Donegan WL, Lewis JD: Clinical diagnosis and staging of breast cancer . Semin Oncol 1978;5:373-384. 5. Haagensen CD, Stout AP: Carcinoma of the breast: Criteria of operability . Ann Surg 1943;118:859-868.Crossref 6. Haagensen CD: Diseases of the Breast . Philadelphia, WB Saunders Co, 1971, pp 617-665. 7. Byrd BF Jr, Rogers J: Surgery for catagorically incurable cancer of the breast . Cancer 1969;24:1319-1321.Crossref 8. Harris JR, Levene MB, Hellman S: The role of radiation therapy in the primary treatment of carcinoma of the breast . Semin Oncol 1978;5:403-416. 9. Fletches GH: Textbook of Radiotherapy , ed 2. Philadelphia, Lea & Febiger, 1973. 10. Arnold DJ, Lesnick GH: Survival following mastectomy for stage III breast cancer . Am J Surg 1979;137:362-366.Crossref 11. Zucali R, Uslenghi C, Kenda R, et al: Natural history and survival of inoperable breast cancer treated with radiotherapy and radiotherapy followed by radical mastectomy . Cancer 1975;37:1422-1431.Crossref 12. Morris D, Aisner J, Elias EG, et al: Mastectomy as an adjunct to combination chemotherapy . Arch Surg 1978;113:282-284.Crossref 13. Tormey D, Leone L, Perloff M, et al: Evaluation of intermittent vs. continuous and of Adriamycin vs. methotrexate five drug chemotherapy regimens for breast cancer , abstracted. Proc Am Soc Clin Oncol 1978;19:320. 14. Aisner J, Weinberg V, Perloff M, et al: Chemoimmunotherapy for advanced breast cancer: A randomized comparison of six combinations (CMF, CAF vs. CAFVP) each with or without MER immunotherapy: A CALGB study , abstracted. Proc Am Soc Clin Oncol 1981;22:443. 15. Robbins GE, Shaw J, Rosen P, et al: Inflammatory carcinoma of the breast . Surg Clin North Am 1974;74:801-810. 16. Simpson-Herner L, Sanford H, Holmquist JP: Effects of surgery on the cell kinetics of residual tumor . Cancer Treat Rep 1976;60:1749-1760. 17. Schiffer LM, Braunschweiger PG, Stragand JJ: Tumor cell population kinetics following non-curative treatment . Antibiot Chemother 1978;23:148-156. 18. Fletcher GH: Clinical dose-response curves of human malignant epithelial tumors . Br J Radiol 1973;46:1-12.Crossref 19. Barker JL, Montague ED, Peters LJ: Clinical experience with irradiation of inflammatory carcinoma of the breast with and without elective chemotherapy . Cancer 1980;45:625-629.Crossref 20. Wang CC: Management of inflammatory carcinoma of the breast . Int J Radiat Oncol Biol Phys 1978;4:709-710.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Mastectomy as an Adjuvant to Chemotherapy for Locally Advanced or Metastatic Breast Cancer

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1982.01380310008003
Publisher site
See Article on Publisher Site

Abstract

Abstract • Patients with unresectable tumors require local treatment of ulcerating or fungating masses. Chemotherapy can shrink the tumor, permitting mastectomy. Continued chemotherapy treats the overt or micrometastases. Of 27 patients with bulky primary tumors, 15 had overt metastases and 12 did not. Thirteen of the 27 had inflammatory carcinoma. After three to four chemotherapy courses, 24 patients were operable, and 22 underwent mastectomy. Eighteen of the 22 had closure without skin grafts. In three, disease recurred at the primary site, and in five at both primary and distal sites. Preoperatively, one patient (4%) achieved complete response and 19 (70%) achieved partial response. After mastectomy, five patients with metastases in stable partial response further responded to chemotherapy and achieved complete response. Chemotherapy with adjuvant mastectomy is technically feasible and offers the possibility of improved duration of survival in some patients. (Arch Surg 1982;117:882-887) References 1. McLelland R: Mammography in the detection, diagnosis and management of carcinoma of the breast . Surg Gynecol Obstet 1978;146:735-740. 2. Fisher B: Surgery of primary breast cancer , in McGuire WL (ed): Breast Cancer: Advances in Research and Treatment . New York, Plenum Medical Book Co, 1977, vol 1, pp 1-37. 3. Cutler SJ: Classification of extent of disease in breast cancer . Semin Oncol 1974;1:91-96. 4. Donegan WL, Lewis JD: Clinical diagnosis and staging of breast cancer . Semin Oncol 1978;5:373-384. 5. Haagensen CD, Stout AP: Carcinoma of the breast: Criteria of operability . Ann Surg 1943;118:859-868.Crossref 6. Haagensen CD: Diseases of the Breast . Philadelphia, WB Saunders Co, 1971, pp 617-665. 7. Byrd BF Jr, Rogers J: Surgery for catagorically incurable cancer of the breast . Cancer 1969;24:1319-1321.Crossref 8. Harris JR, Levene MB, Hellman S: The role of radiation therapy in the primary treatment of carcinoma of the breast . Semin Oncol 1978;5:403-416. 9. Fletches GH: Textbook of Radiotherapy , ed 2. Philadelphia, Lea & Febiger, 1973. 10. Arnold DJ, Lesnick GH: Survival following mastectomy for stage III breast cancer . Am J Surg 1979;137:362-366.Crossref 11. Zucali R, Uslenghi C, Kenda R, et al: Natural history and survival of inoperable breast cancer treated with radiotherapy and radiotherapy followed by radical mastectomy . Cancer 1975;37:1422-1431.Crossref 12. Morris D, Aisner J, Elias EG, et al: Mastectomy as an adjunct to combination chemotherapy . Arch Surg 1978;113:282-284.Crossref 13. Tormey D, Leone L, Perloff M, et al: Evaluation of intermittent vs. continuous and of Adriamycin vs. methotrexate five drug chemotherapy regimens for breast cancer , abstracted. Proc Am Soc Clin Oncol 1978;19:320. 14. Aisner J, Weinberg V, Perloff M, et al: Chemoimmunotherapy for advanced breast cancer: A randomized comparison of six combinations (CMF, CAF vs. CAFVP) each with or without MER immunotherapy: A CALGB study , abstracted. Proc Am Soc Clin Oncol 1981;22:443. 15. Robbins GE, Shaw J, Rosen P, et al: Inflammatory carcinoma of the breast . Surg Clin North Am 1974;74:801-810. 16. Simpson-Herner L, Sanford H, Holmquist JP: Effects of surgery on the cell kinetics of residual tumor . Cancer Treat Rep 1976;60:1749-1760. 17. Schiffer LM, Braunschweiger PG, Stragand JJ: Tumor cell population kinetics following non-curative treatment . Antibiot Chemother 1978;23:148-156. 18. Fletcher GH: Clinical dose-response curves of human malignant epithelial tumors . Br J Radiol 1973;46:1-12.Crossref 19. Barker JL, Montague ED, Peters LJ: Clinical experience with irradiation of inflammatory carcinoma of the breast with and without elective chemotherapy . Cancer 1980;45:625-629.Crossref 20. Wang CC: Management of inflammatory carcinoma of the breast . Int J Radiat Oncol Biol Phys 1978;4:709-710.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1982

References