PROLONGED SURVIVAL BY EARLY SALVAGE TREATMENT OF BREAST-CANCER PATIENTS - A RETROSPECTIVE 6-YEAR STUDY

Between 1977 and 1993, 384 breast cancer patients were followed up pos t-operatively every 4 or 6 months with a serum tumour marker panel (CE A-TPA-CA15-3) and the usual imaging techniques. Twenty-eight patients were treated 13.5 +/- 10 months (mean +/- s.d.) before the clinical an d/or radiological occurrence of distant metastases that were suspected because of an increase in the tumour markers (patients treated 'early '). Their outcome was compared with that of 22 similar patients who we re treated only after a definite radiological diagnosis was achieved ( patients treated 'not early'). The median survivals from mastectomy an d salvage treatment were also compared for the two groups. The groups were similar for all the major prognostic factors (menopause, staging, hormone dependency). In the group treated 'early', the lead time from the tumour marker increase to the clinical and radiological signs of metastases was significantly longer than that of the group not treated 'early' (13.5 +/- 10 vs 3.4 +/- 2.8 months respectively; P < 0.001 by unpaired t-test). For patients treated 'early', the survival curves u p to 30 months after salvage treatment and up to 72 months after maste ctomy showed greater survival than those for the patients treated late r (42.9% vs 13.6% and 42.9% vs 22.7% respectively; P = 0.04 in both in stances). These data suggest that treatment triggered by rising tumour markers before clinical and/or radiological appearance of distant met astases can be useful in prolonging both the asymptomatic interval and the duration of response of some relapsed patients. Randomized prospe ctive trials must be encouraged to confirm these data and to better ev aluate the effect on the disease-free survival (DFS) and overall survi val (OS) of 'early' salvage treatment protocols.