Intraarterial induction chemotherapy in locally advanced stage III breast cancer

Abstract

Five-year results are reported on 27 patients with locally advanced breast cancer treated by intraarterial induction chemotherapy followed by radiotherapy and/or surgery with subsequent adjuvant chemotherapy. The cyclic infusion chemotherapy regimen was given over 3 to 6 weeks using Adriamycin (doxorubicin), 5-fluorouracil (5-FU), vincristine, and methotrexate in daily rotation. Regional and systemic side effects were minimal and temporary except in two patients in whom some skin discoloration has remained. Local tumor control and 5-year cures depended on two important factors: whether follow-up mastectomy was used after initial local tumor regression; and whether the carcinoma was classified as "inflammatory" with pathologic evidence of tumor invasion of dermal lymphatics. Of 16 patients with noninflammatory carcinoma treated by chemotherapy, radiotherapy, and mastectomy local tumor eradication was achieved in 15 and 5-year apparent cure in 11. Of six patients with noninflammatory carcinoma treated with chemotherapy and radiotherapy but no mastectomy 5-year local control was achieved in only three and 5-year apparent cure in three. Of five patients with pathologic inflammatory carcinoma local tumor control was achieved in only one and only this one patient has been a 5-year survivor apparently tumor-free.

Clinical efficacy and value of redistributed subclavian arterial infusion chemotherapy for locally advanced breast cancer

“…1,2 Arterial infusion chemotherapy is not a standard therapy, but it is sometimes performed with the aim of down-staging or for local control. There are some reports of arterial infusion chemotherapy [3][4][5][6][7][8][9][10] and a catheter port system, 11 which as neoadjuvant chemotherapy attained high local control (70%-90%).…”

The management of locally advanced breast cancer

“…If higher doses of cytotoxic drugs could be delivered to tumours safely, higher tumour cell kill might be achieved. Intra-arterial chemotherapy has shown some promise (Stephens, 1990), although not all experience has been favourable (Twelves et al, 1990), and this method of treatment is not yet established. Intensification of systemic chemotherapy with bone marrow support by the use of haemopoietic growth factors or autologous bone marrow transplantation could be another way forward.…”

Intra-Arterial Infusion Chemotherapy in the Treatment of Locally Advanced Breast Cancer

“…There are reports in the literature of a 100%1 response rate with IACT (4,15,16). In this series the objective response rate was 66.6'1/0.…”

“…The response of the primary tumor to initial systemic chemotherapy has been found to be effective in allowing successful surgical removal in the majority of patients. Recently, some authors advocated the administration of induction chemotherapy through the intra-arterial route rather than the systemic route for a faster and higher response (4)(5)(6)(7). In many studies, a significant downstaging of disease by administration of neoadjuvant IACT was demonstrated (8)(9)(10).…”