Combined chemotherapy and radiotherapy for locally advanced breast cancer

Rubens, Robert; Sexton, Sheila; Tong, David; Winter, P.; Knight, R.; Hayward, John

doi:10.1016/0014-2964(80)90352-7

Cited by 117 publications

(56 citation statements)

References 4 publications

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“…Where appropriate, patients were entered into clinical trials related to the management of the primary tumour (van Dongen et al, 1991) and to the use of systemic therapies (Rubens et al, 1980(Rubens et al, , 1983(Rubens et al, , 1989Nolvadex Adjuvant Trial Organisation, 1988;Richards et al, 1990;Scottish Cancer Trials Breast Group, 1993;Fentiman et al, 1994). In over 90% of all operable cases, histological assessment of axillary lymph node status was undertaken, usually following full axillary dissection.…”

Section: Managementmentioning

confidence: 99%

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

et al. 1999

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SummaryThe aim of this study was to examine the possible influence on survival of delays prior to presentation and/or treatment among women with breast cancer. Duration of symptoms prior to hospital referral was recorded for 2964 women who presented with any stage of breast cancer to Guy's Hospital between 1975 and. Median follow-up is 12.5 years. The impact of delay (defined as having symptoms for 12 or more weeks) on survival was measured from the date of diagnosis and from the date when the patient first noticed symptoms to control for lead-time bias. Thirty-two per cent (942/2964) of patients had symptoms for 12 or more weeks before their first hospital visit and 32% (302/942) of patients with delays of 12 or more weeks had locally advanced or metastatic disease, compared with only 10% (210/2022) of those with delays of less than 12 weeks (P < 0.0001). Survival measured both from the date of diagnosis (P < 0.001) and from the onset of the patient's symptoms (P = 0.003) was worse among women with longer delays. Ten years after the onset of symptoms, survival was 52% for women with delays less than 12 weeks and 47% for those with longer delays. At 20 years the survival rates were 34% and 24% respectively. Furthermore, patients with delays of 12-26 weeks had significantly worse survival rates than those with delays of less than 12 weeks. Multivariate analyses indicated that the adverse impact of delay in presentation on survival was attributable to an association between longer delays and more advanced stage. However, within individual stages, longer delay had no adverse impact on survival. Analyses based on 'total delay' (i.e. the interval between a patient first noticing symptoms and starting treatment) yielded very similar results in terms of survival to those based on delay to first hospital visit (delay in presentation).

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Section: Managementmentioning

confidence: 99%

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

et al. 1999

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“…However, even though preoperative chemotherapy resulted in high rates of short-term response and changed the natural history of LABC, there is no apparent improvement in long-term survival. [3][4][5] One of the main reasons may be due to the low-dose intensity used in most trials. HDC/PBSCs prior to surgery may increase dose intensity of chemotherapy and effect in the management of LABC.…”

Section: Discussionmentioning

confidence: 99%

Preoperative high-dose chemotherapy with peripheral blood stem cell support as a primary management of locally advanced breast cancer

Wang

Tang

et al. 2001

Bone Marrow Transplant

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Summary:Locally advanced breast cancer (LABC) has a poor prognosis with a high risk of local recurrence and distant metastasis. Preoperative combined chemotherapy with or without granulocyte colony-stimulating factor (G-CSF) support does not improve the long-term survival rate. In our report, two patients with LABC received preoperative high-dose chemotherapy with peripheral blood stem cell support (HDC/PBSCs). Prior to high-dose chemotherapy with peripheral blood stem cell support, they both received induction chemotherapy of cyclophosphamide, epirubicin and 5-fluorouracil (FEC) for two cycles which resulted in a partial response. PBSC mobilization and collection were carried out following the second cycle of induction chemotherapy followed by G-CSF. High-dose cyclophosphamide (2500 mg/m 2 ), carboplatin (600 mg/m 2 ) and etoposide (600 mg/m 2 ) were administered with PBSC support. A radical mastectomy was performed followed by adjuvant chemotherapy with FEC regimen for four cycles, followed by local irradiation, and endocrine therapy with tamoxifen. Both patients achieved a remarkable response in the primary lesion after HDC/PBSCs and tolerated the whole treatment well. Preoperative HDC/PBSCs as a new strategy in the treatment of LABC seems practical but it needs to be studied more deeply. Bone Marrow Transplantation (2001) 27, 345-346. Keywords: breast cancer; peripheral blood stem cell; high-dose chemotherapy High-dose chemotherapy with peripheral blood stem cell support for breast cancer has been developed for over 10 years on the basis of dose-response effects. In most clinical trials, high-dose chemotherapy with peripheral blood stem cell support is only used as a post-operative adjuvant chemotherapy for breast cancer with high risk and as a palliative therapy for metastatic breast cancer. No clinical trial of high-dose chemotherapy with peripheral blood stem cell

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“…Similar study by Rubens and associates found neo-adjuvant CT with AV (Adriamycin and vincristine) for 4 cycles produced objective responses of 83% cases. 35 Buzdar et al of MD Anderson Cancer Centre used 3 courses of neoadjuvant CT (CAF) in 174 stage III patients and found objective response of 88%. 36 The present study showed after 3 cycles of induction CT (CAF) on 28 patients, 82.1% patients showed objective response to therapy.…”

Section: Discussionmentioning

confidence: 99%

Loco-regionally advance breast cancer: evaluation of management of breast cancer with special reference to multimodal approach

et al. 2016

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Background: Breast cancer is one of the most common human neoplasms, accounting for approximately one-quarter of all cancers in females worldwide and 27% of cancers in developed countries with a western lifestyle. The aims of this study were to evaluate the management of loco-regionally advanced carcinoma of breast with special reference to multimodal approach. Methods: The study was conducted on patients with loco-regionally advanced carcinoma of breast, reporting for treatment in a large multi-specialty teaching institute. All patients of stage IIIB were initially treated with neoadjuvant (induction) chemotherapy (3 cycles), except 4 patients in the study group offered surgery as initial treatment because of small tumor size with limited peu'd orange change in the skin. After this treatment all patients were reassessed with a thorough clinical examination and restaging work upto detect the response of the chemotherapy. All patients who achieved objective response (complete + partial) were offered surgery, followed by CT and RT. Results: About 60% of the patients were in stage IIIB and 32% in stage IIIA. Majority of the tumors were in T4 category (64%). In 28% cases ipsilateral fixed lymph nodes were found. Histopathological examination revealed 76% (38) patients with infiltrating duct carcinoma, 4 patients (8%) had comedo carcinoma, 2 patients (4%) had lobular carcinoma, 2 patients (4%) had medullary carcinoma and 4 patients (8%) had mucinous carcinoma. Both nonresponsive (NR) and disease progression (DP) patients were in stage III B group. About 76.9% patients of stage IIIB (20) achieved partial response. Only 1 patient (33.3%) developed local recurrence after 10 months of completion of treatment. Median disease free survival (DFS) period of this group is 30.2 months. Recurrence rate is stage IIIA patients was 27.7% and in stage IIIB 37.5%. Maximum numbers of disease free patients were found in T3N1 group (85.7%). Patient with N2 and T4 disease chances of recurrence was more than N1 and T3 lesions. Conclusions: Patients with LBAC who are able to complete treatment with chemotherapy, mastectomy, and postmastectomy radiation have a high probability of locoregional control. Neo-adjuvant chemotherapy can make inoperable locally advanced breast cancer operable and with the use of neo-adjuvant CT, breast conservation surgery is possible even in locally advanced breast cancer. Use of post-operative CT and RT can increase the disease free survival period. Use of multimodal treatment in the form of CT, surgery and radiotherapy can increase the disease free survival period in locally advanced breast cancer. The advent of successful multimodal regimens incorporating systemic treatment (chemotherapy or chemohormonal therapy) as well as local therapy (surgery and radiation) has significantly improved disease-free and overall survival as well as local-regional control. Longer follow-up of these conservatively treated patients will be needed, however, to determine whether local-regional control is preserved.

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Combined chemotherapy and radiotherapy for locally advanced breast cancer

Cited by 117 publications

References 4 publications

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

Preoperative high-dose chemotherapy with peripheral blood stem cell support as a primary management of locally advanced breast cancer

Loco-regionally advance breast cancer: evaluation of management of breast cancer with special reference to multimodal approach

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