Primary Chemotherapy To Avoid Mastectomy in Tumors With Diameters of Three Centimeters or More

Abstract

In 165 women with breast cancer who were candidates for mastectomy because the largest diameter of the tumor was 3 cm or more, we administered primary chemotherapy in the attempt to substitute conservative for mutilating surgery. We then systematically quantitated tumor reduction by clinical, radiologic, and histopathologic evaluations. Five consecutive groups of 33 patients received cyclophosphamide, methotrexate, and fluorouracil (CMF); fluorouracil, doxorubicin (Adriamycin), and cyclophosphamide (FAC); or fluorouracil, epirubicin, and cyclophosphamide (FEC). The regimens for the five groups were as follows: group 1, three cycles of CMF; group 2, four cycles of CMF; group 3, three cycles of FAC; group 4, four cycles of FAC; and group 5, three cycles of FEC. In response to primary chemotherapy, 157 of the 161 assessable patients showed measurable tumor shrinkage; progressive disease was documented in four. Tumor shrinkage to less than 3 cm was documented in 127 (81%) of the 157 women subjected to surgery, thus allowing a breast-saving procedure, rather than modified radical mastectomy, in these 127 women. Histopathologic complete remission was documented in seven patients. Tumor response was unrelated to age, menopausal status, DNA content (ploidy), [3H]thymidine-labeling index, drug combination used, or number of treatment cycles in excess of three. The degree of response was inversely proportional to the initial tumor size, and the frequency of response was greater in receptor-negative tumors. Severe vomiting and hair loss were less frequent with CMF than with anthracycline-containing regimens, and the frequency of severe leukopenia and thrombocytopenia was minimal. Our results challenge the classical indication for primary mastectomy by showing that use of full-dose primary chemotherapy, sequentially combined with conservative surgery and radiation, can offer an effective and safe alternative to women concerned about the preservation of body integrity.

Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

“…This apparently worse response rate to chemotherapy after failed hormone therapy has also been noted in metastatic disease (Swenerton et al, 1979). Impaired response to chemotherapy in untreated ER-moderate/ -rich tumours has been previously noted (Bonadonna et al, 1990;Mauriac et al, 1991;Belembaogo et al, 1992). However, the known effects of hormone therapy upon breast cancer could further prejudice the subsequent response to chemotherapy.…”

Assessment of the effect of pretreatment with neoadjuvant therapy on primary breast cancer

“…Thirteen (27.6%) had a complete regression. Others (Bonadonna et al, 1990) In premenopausal women with advanced breast cancer LHRH agonists will reduce serum oestradiol levels to the equivalent of the menopause or surgical oophorectomy (Dixon et al, 1990). These agents have an indirect action by reducing peripheral hormones rather than acting directly on LHRH receptors on the tumour (Harris et al, 1989).…”

Increase in response rate by prolonged treatment with neoadjuvant letrozole

“…References [1][2][3][4] Studies comparing neoadjuvant with adjuvant chemotherapy have shown that while disease-free, progression-free and overall survival are not changed by the timing of treatment, better outcomes are seen in patients who respond to neoadjuvant therapy [5][6][7]. These results highlight a key benefit of neoadjuvant therapy, the use of response to predict long-term outcome.…”