Multimodal therapy for locally advanced breast cancer
M. Morrow, A. Braverman, W. Thelmo, C. K. Sohn, J. Sand, M. Mora, T. Forlenza and J. Marti
Thirty-one women with stage III breast cancer were prospectively treated
with two cycles of cyclophosphamide (Cytoxan), doxorubicin hydrochloride
(Adriamycin), fluorouracil, and tamoxifen citrate followed by a simple
mastectomy with level I axillary dissection. Postoperatively, four
additional cycles of the combination chemotherapy alternating with three
cycles of 1500 rad (15 Gy) to the chest wall and lymphatics were given.
Seventy-seven percent of patients had a greater than 50% reduction in tumor
size after the initial chemotherapy. No tumor size progressed during
therapy, and a single patient remained inoperable. Pathologic findings
revealed nine patients with only microscopic residual tumor. Nuclear
vacuolization was present in 42.8% of tumor cells after chemotherapy vs
14.2% of cells before chemotherapy. The mean follow-up for the groups is
24.3 months. To date, nine patients have had recurrence with only one
isolated local recurrence. This therapy is effective in reducing primary
tumor size and allows a limited mastectomy to be done with minimal
morbidity.
