A pilot evaluation of alternating preoperative chemotherapy in the management of patients with locoregionally advanced breast carcinoma

Thomas M. Pisansky, Charles L. Loprinzi, Stephen S. Cha, Robert Joseph Fitzgibbons, Clive S. Grant, A. Curtis Hass, Nicholas F. Reuter, Lester E. Wold, James N. Ingle, Carl G. Kardinal

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Abstract

BACKGROUND. This prospective trial was conducted to evaluate the outcome of patients treated with preoperative and postoperative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma. METHODS. Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor-positive tumors, was used after mastectomy. Post-operative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence. RESULTS. Although 5 patients (7%) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65%). Sixty-eight patients (96%) underwent mastectomy. With a median follow-up of 52 months, the relapse-free and overall survival rates at 5 years were 42% and 57%, respectively. Locoregional tumor recurrence occurred in 14 patients (20%), and 28 patients (39%) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome. CONCLUSIONS. Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse-free and overall survival estimates for the approach described herein compared favorably with other contemporary reports for this condition.

Original languageEnglish
Pages (from-to)2520-2528
Number of pages9
JournalCancer
Volume77
Issue number12
DOIs
StatePublished - Jun 15 1996

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Breast Neoplasms
Drug Therapy
Mastectomy
Recurrence
Neoplasms
Tamoxifen
Methotrexate
Fluorouracil
Doxorubicin
Cyclophosphamide
Disease Progression
Survival Rate
Hormones
Survival

All Science Journal Classification (ASJC) codes

  • Cancer Research
  • Oncology

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A pilot evaluation of alternating preoperative chemotherapy in the management of patients with locoregionally advanced breast carcinoma. / Pisansky, Thomas M.; Loprinzi, Charles L.; Cha, Stephen S.; Fitzgibbons, Robert Joseph; Grant, Clive S.; Hass, A. Curtis; Reuter, Nicholas F.; Wold, Lester E.; Ingle, James N.; Kardinal, Carl G.

In: Cancer, Vol. 77, No. 12, 15.06.1996, p. 2520-2528.

Research output: Contribution to journalArticle

Pisansky, Thomas M. ; Loprinzi, Charles L. ; Cha, Stephen S. ; Fitzgibbons, Robert Joseph ; Grant, Clive S. ; Hass, A. Curtis ; Reuter, Nicholas F. ; Wold, Lester E. ; Ingle, James N. ; Kardinal, Carl G. / A pilot evaluation of alternating preoperative chemotherapy in the management of patients with locoregionally advanced breast carcinoma. In: Cancer. 1996 ; Vol. 77, No. 12. pp. 2520-2528.
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abstract = "BACKGROUND. This prospective trial was conducted to evaluate the outcome of patients treated with preoperative and postoperative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma. METHODS. Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor-positive tumors, was used after mastectomy. Post-operative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence. RESULTS. Although 5 patients (7{\%}) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65{\%}). Sixty-eight patients (96{\%}) underwent mastectomy. With a median follow-up of 52 months, the relapse-free and overall survival rates at 5 years were 42{\%} and 57{\%}, respectively. Locoregional tumor recurrence occurred in 14 patients (20{\%}), and 28 patients (39{\%}) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome. CONCLUSIONS. Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse-free and overall survival estimates for the approach described herein compared favorably with other contemporary reports for this condition.",
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T1 - A pilot evaluation of alternating preoperative chemotherapy in the management of patients with locoregionally advanced breast carcinoma

AU - Pisansky, Thomas M.

AU - Loprinzi, Charles L.

AU - Cha, Stephen S.

AU - Fitzgibbons, Robert Joseph

AU - Grant, Clive S.

AU - Hass, A. Curtis

AU - Reuter, Nicholas F.

AU - Wold, Lester E.

AU - Ingle, James N.

AU - Kardinal, Carl G.

PY - 1996/6/15

Y1 - 1996/6/15

N2 - BACKGROUND. This prospective trial was conducted to evaluate the outcome of patients treated with preoperative and postoperative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma. METHODS. Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor-positive tumors, was used after mastectomy. Post-operative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence. RESULTS. Although 5 patients (7%) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65%). Sixty-eight patients (96%) underwent mastectomy. With a median follow-up of 52 months, the relapse-free and overall survival rates at 5 years were 42% and 57%, respectively. Locoregional tumor recurrence occurred in 14 patients (20%), and 28 patients (39%) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome. CONCLUSIONS. Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse-free and overall survival estimates for the approach described herein compared favorably with other contemporary reports for this condition.

AB - BACKGROUND. This prospective trial was conducted to evaluate the outcome of patients treated with preoperative and postoperative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma. METHODS. Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor-positive tumors, was used after mastectomy. Post-operative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence. RESULTS. Although 5 patients (7%) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65%). Sixty-eight patients (96%) underwent mastectomy. With a median follow-up of 52 months, the relapse-free and overall survival rates at 5 years were 42% and 57%, respectively. Locoregional tumor recurrence occurred in 14 patients (20%), and 28 patients (39%) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome. CONCLUSIONS. Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse-free and overall survival estimates for the approach described herein compared favorably with other contemporary reports for this condition.

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