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

Aisner, Joseph; Morris, Don M.; Elias, E. George; Wiernik, Peter H.

doi:10.1001/archsurg.1982.01380310008003

Cited by 35 publications

(4 citation statements)

References 11 publications

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“…However, the local control rate in the studies was relatively low, in the 60%-70% range. In contrast, those phase II studies in which primary CT was followed by both surgery and RT have reported higher local control rates, in some cases reaching 85% (Table 6) [4,20,21,23,25,[44][45][46]. In our first two studies (367 patients), the locoregional failure rate for stage IIB/IIIA and IIIB/regional IV were 7% and 26%, respectively [15].…”

Section: Local/regional Treatment and Local Controlcontrasting

confidence: 54%

Locally Advanced Breast Cancer

1996

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Locally advanced breast cancer encompasses a heterogeneous collection of breast neoplasms and constitutes approximately 10%-20% of the newly diagnosed breast cancers. These cancers may have widely different clinical and biological characteristics. Patients with these tumors may be classified as stage IIB, III or IV breast cancer according to the American Joint Committee for Cancer Staging and End Results Reporting (TNM classification). Multidisciplinary therapy has become the treatment of choice for these patients. Primary or neoadjuvant chemotherapy followed by locoregional therapy, either surgery and/or radiotherapy, and postoperative systemic chemotherapy is now an accepted strategy. More than 70% of patients achieve an objective response (including pathological complete remission in 10%-25% of cases), and many patients experience downstaging through primary chemotherapy. Breast conservation is possible in 10%-40% of patients with locally advanced breast cancer; almost all patients initially are rendered disease-free, and long-term local control is achieved in over 70% of these patients. Primary chemotherapy is the initial choice of treatment for patients with locally advanced tumors, but it is unclear what the optimal sequence of subsequent therapies should be, whether one or two local treatment modalities are necessary, and whether any or different postoperative chemotherapy is needed. The efficacy of primary chemotherapy was demonstrated in several large prospective studies in patients with locally advanced breast cancer. The natural history of this disease was changed dramatically by the introduction of these combined modality therapies. Five-year disease-free survival rates of 35%-70% are commonly reported, and about 25%-40% of patients will survive beyond 10 years without recurrence. In summary, multidisciplinary therapy that includes primary chemotherapy provides appropriate local control and the possibility of breast conservation therapy; it increases surgical resectability and survival rates in patients with locally advanced breast cancer. The role of new innovative therapeutic strategies such as high-dose chemotherapy, with hematopoietic stem cell rescue, new cytotoxic agents and higher dose-intensity therapy is currently under evaluation in patients with locally advanced breast cancer.

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Section: Local/regional Treatment and Local Controlcontrasting

confidence: 54%

Locally Advanced Breast Cancer

1996

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“…The advantages to neoadjuvant chemotherapy are multiple. By reducing tumor volume for patients with large breast tumors, this approach may permit breast-conservation surgery rather than mastectomy [2][3][4][5][6]. Unlike conventional adjuvant chemotherapy that may be delayed for several months because of surgical scheduling and the need for wound healing, neoadjuvant chemotherapy allows earlier treatment of micrometastatic disease [7].…”

mentioning

confidence: 99%

Prospective Comparison of Mammography, Sonography, and MRI in Patients Undergoing Neoadjuvant Chemotherapy for Palpable Breast Cancer

Yeh

Slanetz

Kopans

et al. 2005

American Journal of Roentgenology

370

221

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“…A large number of studies in the literature report single arm trials using chemotherapy in combination with surgery, radio-therapy, or both, as well as retrospective reviews [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. The median time to progression varies from 21 to 30 months in these series, with 5-year relapse-free and overall survival being heavily dependent on stage subset.…”

Section: Nonrandomized Trials Of Multimodality Treatment Of Labcmentioning

confidence: 99%

Management of locally advanced breast cancer

Borgen

1994

World j. surg.

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The management of locally advanced breast cancer with single modality therapy has been associated with a high rate of systemic failure. A multimodality treatment strategy that includes induction cytotoxic chemotherapy, surgery, radiation therapy, and, possibly, hormonal ablation therapy is the current preferred management approach. As our knowledge and understanding of the mechanisms involved in mitogenic signal transduction improve, it is likely that less toxic, more efficacious agents will emerge.

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

Cited by 35 publications

References 11 publications

Locally Advanced Breast Cancer

Locally Advanced Breast Cancer

Prospective Comparison of Mammography, Sonography, and MRI in Patients Undergoing Neoadjuvant Chemotherapy for Palpable Breast Cancer

Management of locally advanced breast cancer

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