Neoadjuvant chemotherapy before definitive treatment for stage III carcinoma of the breast
G. F. Schwartz, R. I. Cantor and W. A. Biermann
Department of Surgery, Jefferson Medical College, Philadelphia, PA.
One hundred women with American Joint Committee (AJC) stage III (T2, N2;
T3, N0/1/2; T4, N0/1/2) carcinoma of the breast were treated with
combination chemotherapy following biopsy to confirm the diagnosis and
determine hormone receptor status before any other treatment of the local
disease (so-called neoadjuvant chemotherapy). Response was assessed after
three cycles of treatment, and responders were treated until the tumor
and/or axillary nodes failed to show further regression. Definitive surgery
was then performed, usually radical mastectomy. Chemotherapy was resumed
following surgery for a total of 12 cycles. Ninety patients are assessable,
and 70% have responded to chemotherapy. Outcomes of both responders and
nonresponders were analyzed. Radical mastectomy without postoperative
radiotherapy seems to be the preferable surgical treatment for the
responders. Median follow-up of the assessable patients was 27 months;
projected five-year disease-free survival of the responders is greater than
65%, and projected overall five-year survival of this group is greater than
85%. Because the follow-up of these patients suggests a marked improvement
in outcome compared with similar patients treated traditionally with
mastectomy or radiotherapy followed by adjuvant chemotherapy, we advocate
more widespread use of combination chemotherapy before definitive treatment
for stage III carcinomas of the breast.
