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Multimodality Treatment of Locally Advanced Breast Carcinoma

Multimodality Treatment of Locally Advanced Breast Carcinoma Abstract • Forty patients with 41 locally advanced breast lesions at stages IIIA and IIIB and the inflammatory stage were treated with combined-modality therapy from July 1980 to August 1985. Treatment included induction chemotherapy consisting of three cycles of fluorouracil, doxorubicin hydrochloride, and cyclophosphamide, followed by mastectomy in those patients whose lesions were operable (n=28), and resumption of chemotherapy. Nine patients received postoperative radiation therapy. The mean follow-up was 34 months. Greater than 50% reduction in tumor size was achieved in 72% of patients after three cycles of chemotherapy. Overall, local control was achieved in 85% of patients with 59% survival and 53% disease-free survival, while 10% of patients developed local recurrences. Excluding lymphedema of the upper extremity (n=2) and inflammatory carcinomas (n=4), local control was achieved in 96% of patients, with 75% survival and 68% disease-free survival, while 4% of patients developed local recurrences. The rate of disease-free survival was 71% in patients with partial response to chemotherapy, contrasted with 43% in patients who did not respond or only minimally responded to chemotherapy. Actuarial five-year survival, based on life-table analysis, was calculated to be 46% for the group overall, 58% for the group excluding lymphedema of the upper extremity and inflammatory carcinoma, and 56% for the 28 patients undergoing mastectomy. (Arch Surg 1988;123:951-955) References 1. Canellos GP: The treatment of locally advanced breast cancer . J Clin Oncol 1984;2:149-151. 2. Bruckman JE, Harris JR, Hellman S: Results of treating stage III carcinoma of the breast by primary radiation therapy . Cancer 1979;43:985-993.Crossref 3. Terz JJ, Romero CA, Kay S: Preoperative radiotherapy for stage III carcinoma of the breast . Surg Gynecol Obstetr 1978;147:497-502. 4. Zucali R, Uslenghi C, Kenda R: Natural history and survival of inoperable breast cancer treated with radiotherapy and radiotherapy followed by radical mastectomy . Cancer 1976;37:1422-1431.Crossref 5. Haagensen CD: Diseases of the Breast , ed 3. Philadelphia, WB Saunders Co, 1986. 6. Harris JR, Hellman S: The role of radiation therapy in the management of locally advanced carcinoma of the breast . Cancer 1984;53( (suppl) ):758-761.Crossref 7. Hortobagyi GN, Blumenschein GR, Spanos W: Multimodal treatment of locoregionally advanced breast cancer . Cancer 1983;51:763-768.Crossref 8. Balawadjer I, Antich PP, Boland J: An analysis of the role of radiotherapy alone and in combination with chemotherapy and surgery in the management of advanced breast carcinoma . Cancer 1983;51:574-580.Crossref 9. Grohn P, Heinonen E, Klefstrom P: Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in stage III breast cancer . Cancer 1984;54:670-674.Crossref 10. Shanta V, Krishnamurthi S, Sastry D: Multimodal approach in the therapy of stage III female breast cancer . J Surg Oncol 1985;28:134-136.Crossref 11. Papaioannou A, Lissaios B, Vasilaros S: Pre- and postoperative chemoendocrine treatment with or without postoperative radiotherapy for locally advanced breast cancer . Cancer 1983;51:1284-1290.Crossref 12. Hery M, Namer M, Moro M: Conservative treatment (chemotherapy/radiotherapy) of locally advanced breast cancer . Cancer 1986;57:1744-1749.Crossref 13. DeLena M, Varini M, Zucali R: Multimodal treatment for locally advanced breast cancer . Cancer Clin Trials 1981;4:229-236. 14. Hortobagyi GN, Kau SW, Buzdar AU, et al: Induction chemotherapy for stage III primary breast cancer . Adjuvant Ther Cancer 1987;5:419-428. 15. Sponzo RW, Cunningham TJ, Caradonna RR: Management of nonresectable (stage III) breast cancer . Int J Radiat Oncol Biol Phys 1979;5:1475-1478.Crossref 16. Stjernswand J: Adjuvant radiotherapy trials in breast cancer . Cancer 1977;39:2846-2867.Crossref 17. Tapley N, Spanos W, Fletcher G: Result in patients with breast cancer treated by radical mastectomy and postoperative irradiation with no adjuvant chemotherapy . Cancer 1982;49:1316-1319.Crossref 18. Host H, Brennhod I: The effect of postoperative radiotherapy in breast cancer . Int J Radiat Oncol Biol Phys 1977;2:1061-1064.Crossref 19. Sorace RA, Bagley CS, Lippman ME: The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery . World J Surg 1985;9:775-785.Crossref 20. Swain SM, Sorace RA, Bagley CS, et al: Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer . Cancer Res 1987;47:3889-3894. 21. Sicher K, Waterhouse JAH: Evaluation of TNM classification of carcinoma of the breast . Br J Cancer 1973;28:580-588.Crossref 22. Lucas FP, Perez-Mesa C: Inflammatory cancer of the breast . Cancer 1978;41:1595-1605.Crossref 23. Fastenberg NA, Buzdar AU, Montague ED, et al: Management of inflammatory carcinoma of the breast: A combined modality approach . Am J Clin Oncol 1985;8:134-141.Crossref 24. Buzdar AU, Montague ED, Barker JL, et al: Management of inflammatory breast carcinoma with combined modality approach: An update . Cancer 1981;47:2537-2542.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Multimodality Treatment of Locally Advanced Breast Carcinoma

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400320037006
Publisher site
See Article on Publisher Site

Abstract

Abstract • Forty patients with 41 locally advanced breast lesions at stages IIIA and IIIB and the inflammatory stage were treated with combined-modality therapy from July 1980 to August 1985. Treatment included induction chemotherapy consisting of three cycles of fluorouracil, doxorubicin hydrochloride, and cyclophosphamide, followed by mastectomy in those patients whose lesions were operable (n=28), and resumption of chemotherapy. Nine patients received postoperative radiation therapy. The mean follow-up was 34 months. Greater than 50% reduction in tumor size was achieved in 72% of patients after three cycles of chemotherapy. Overall, local control was achieved in 85% of patients with 59% survival and 53% disease-free survival, while 10% of patients developed local recurrences. Excluding lymphedema of the upper extremity (n=2) and inflammatory carcinomas (n=4), local control was achieved in 96% of patients, with 75% survival and 68% disease-free survival, while 4% of patients developed local recurrences. The rate of disease-free survival was 71% in patients with partial response to chemotherapy, contrasted with 43% in patients who did not respond or only minimally responded to chemotherapy. Actuarial five-year survival, based on life-table analysis, was calculated to be 46% for the group overall, 58% for the group excluding lymphedema of the upper extremity and inflammatory carcinoma, and 56% for the 28 patients undergoing mastectomy. (Arch Surg 1988;123:951-955) References 1. Canellos GP: The treatment of locally advanced breast cancer . J Clin Oncol 1984;2:149-151. 2. Bruckman JE, Harris JR, Hellman S: Results of treating stage III carcinoma of the breast by primary radiation therapy . Cancer 1979;43:985-993.Crossref 3. Terz JJ, Romero CA, Kay S: Preoperative radiotherapy for stage III carcinoma of the breast . Surg Gynecol Obstetr 1978;147:497-502. 4. Zucali R, Uslenghi C, Kenda R: Natural history and survival of inoperable breast cancer treated with radiotherapy and radiotherapy followed by radical mastectomy . Cancer 1976;37:1422-1431.Crossref 5. Haagensen CD: Diseases of the Breast , ed 3. Philadelphia, WB Saunders Co, 1986. 6. Harris JR, Hellman S: The role of radiation therapy in the management of locally advanced carcinoma of the breast . Cancer 1984;53( (suppl) ):758-761.Crossref 7. Hortobagyi GN, Blumenschein GR, Spanos W: Multimodal treatment of locoregionally advanced breast cancer . Cancer 1983;51:763-768.Crossref 8. Balawadjer I, Antich PP, Boland J: An analysis of the role of radiotherapy alone and in combination with chemotherapy and surgery in the management of advanced breast carcinoma . Cancer 1983;51:574-580.Crossref 9. Grohn P, Heinonen E, Klefstrom P: Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in stage III breast cancer . Cancer 1984;54:670-674.Crossref 10. Shanta V, Krishnamurthi S, Sastry D: Multimodal approach in the therapy of stage III female breast cancer . J Surg Oncol 1985;28:134-136.Crossref 11. Papaioannou A, Lissaios B, Vasilaros S: Pre- and postoperative chemoendocrine treatment with or without postoperative radiotherapy for locally advanced breast cancer . Cancer 1983;51:1284-1290.Crossref 12. Hery M, Namer M, Moro M: Conservative treatment (chemotherapy/radiotherapy) of locally advanced breast cancer . Cancer 1986;57:1744-1749.Crossref 13. DeLena M, Varini M, Zucali R: Multimodal treatment for locally advanced breast cancer . Cancer Clin Trials 1981;4:229-236. 14. Hortobagyi GN, Kau SW, Buzdar AU, et al: Induction chemotherapy for stage III primary breast cancer . Adjuvant Ther Cancer 1987;5:419-428. 15. Sponzo RW, Cunningham TJ, Caradonna RR: Management of nonresectable (stage III) breast cancer . Int J Radiat Oncol Biol Phys 1979;5:1475-1478.Crossref 16. Stjernswand J: Adjuvant radiotherapy trials in breast cancer . Cancer 1977;39:2846-2867.Crossref 17. Tapley N, Spanos W, Fletcher G: Result in patients with breast cancer treated by radical mastectomy and postoperative irradiation with no adjuvant chemotherapy . Cancer 1982;49:1316-1319.Crossref 18. Host H, Brennhod I: The effect of postoperative radiotherapy in breast cancer . Int J Radiat Oncol Biol Phys 1977;2:1061-1064.Crossref 19. Sorace RA, Bagley CS, Lippman ME: The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery . World J Surg 1985;9:775-785.Crossref 20. Swain SM, Sorace RA, Bagley CS, et al: Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer . Cancer Res 1987;47:3889-3894. 21. Sicher K, Waterhouse JAH: Evaluation of TNM classification of carcinoma of the breast . Br J Cancer 1973;28:580-588.Crossref 22. Lucas FP, Perez-Mesa C: Inflammatory cancer of the breast . Cancer 1978;41:1595-1605.Crossref 23. Fastenberg NA, Buzdar AU, Montague ED, et al: Management of inflammatory carcinoma of the breast: A combined modality approach . Am J Clin Oncol 1985;8:134-141.Crossref 24. Buzdar AU, Montague ED, Barker JL, et al: Management of inflammatory breast carcinoma with combined modality approach: An update . Cancer 1981;47:2537-2542.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1988

References