Journal of Clinical Oncology, Vol 15, 2873-2881, Copyright © 1997 by American Society of Clinical Oncology
Breast conservation and prolonged chemotherapy for locally advanced breast cancer: the University of Michigan experience
SD Merajver, BL Weber, R Cody, D Zhang, M Strawderman, KA Calzone, V LeClaire, A Levin, J Irani, M Halvie, D August, M Wicha, A Lichter and LJ Pierce
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0680, USA. smerajve@umich.edu
PURPOSE: To determine whether breast conservation and prolonged neoadjuvant
chemotherapy have efficacy in locally advanced breast cancer (LABC), as
measured by survival and rate of breast conservation. MATERIALS AND
METHODS: Eighty-nine patients with stage III disease were enrolled at the
University of Michigan (UM) onto a prospective nonrandomized trial.
Patients received nine 21-day cycles of neoadjuvant chemohormonal therapy
that consisted of doxorubicin 30 mg/m2 and cyclophosphamide 750 mg/m2
intravenously on day 1, conjugated estrogens 0.625 mg orally twice daily on
days 6 to 8, methotrexate 40 mg/m2 and fluorouracil 500 mg/m2 intravenously
on day 8, and tamoxifen 10 mg orally twice daily on days 9 to 14. Patients
with a negative biopsy received radiation only, while those with residual
disease underwent mastectomy and postoperative radiotherapy. Eight more
cycles of chemohormonal therapy were administered after local-regional
therapy. RESULTS: The clinical response rate to neoadjuvant therapy was
97%, 28% of patients had a complete pathologic response evaluated at
biopsy. Five-year overall and disease-free survival probabilities were 54%
and 44%, respectively. The median disease-free survival time was 2.4 years.
The 5-year actuarial rates of local-regional control with local failure as
only first failure were 82% and 78% following radiotherapy, and mastectomy
and radiotherapy, respectively (P = .99). CONCLUSION: Prolonged neoadjuvant
chemohormonal therapy and biopsy- driven local therapy have efficacy in
LABC, with 28% of patients being candidates for breast conservation and a
5-year overall survival rate of 54%.
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