CONSERVATIVE TREATMENT FEASIBILITY WITH INDUCTION CHEMOTHERAPY, SURGERY, AND RADIOTHERAPY FOR PATIENTS WITH BREAST-CARCINOMA LARGER THAN 3 CM

Background. The traditional surgical treatment for operable breast car cinoma larger than 3 cm is mastectomy. To avoid mutilating surgery, th e authors administered primary chemotherapy to 158 patients with opera ble nonmetastatic large breast carcinoma with a TNM classification of T2 greater than 3 cm and T3 with a lymph node status of N0-N1. Conserv ative treatment was proposed for patients responding to the chemothera py and whose tumor was reduced to 3 cm or less. The purpose of the stu dy was to evaluate the feasibility and treatment results of this strat egy. Methods. The mean patient age was 50.4 years. Eighty-two patients had T2 carcinomas greater than 3 cm, and 76 had T3 carcinoma. Fifty-f our tumors were classified as lymph node status N0, and 104 as N1. Mea n tumor size was 5.6 cm. Patients were treated with three courses of t he NVCF regimen (mitoxantrone, vindesin, cyclophosphamide, and 5-fluor ouracil) or the EVCF regimen, in which mitoxantrone was replaced by ep irubicin every 4 weeks, and then administered with a radiosurgical com bination. Results. The overall response rate to induction chemotherapy was 60.8% with 20.2% complete tumor regression. Twenty-one percent of the patients experienced grade 3 or 4 chemotherapy toxic effects, whi ch were all acceptable and reversible. Breast-conserving treatment was feasible in 48.7% of patients (77 of 158). Forty-five patients (28.5% ) were treated with a radiosurgical combination (tumorectomy plus radi ation therapy), whereas 32 (20.2%) were treated with radiotherapy alon e (external irradiation and brachytherapy). Other patients were treate d with mastectomy. Age, tumor stage, histology, hormonal status, and h ormonal receptor rate had no influence on the frequency of the observe d regressions. Isolated recurrences occurred in 11 patients, 6 who wer e treated conservatively and 5 who were treated with mastectomy. Metas tatic relapses were observed in 38 patients (14.6% in the chemotherapy responders and 38.7% in the nonresponders) (P < 0.02). Five-year actu arial survival was 73.2% and was significantly higher for responders t o the induction treatment. Conclusion. These preliminary results sugge st that primary chemotherapy and radiosurgical breast-conserving treat ment is feasible and is an alternative to mastectomy for patients with large operable breast carcinoma who are responders to the induction t reatment. The long term benefit of this strategy must be evaluated in well designed controlled trials.