PRIMARY CHEMOTHERAPY AND RADIOSURGICAL BREAST-CONSERVING TREATMENT FOR PATIENTS WITH LOCALLY ADVANCED OPERABLE BREAST CANCERS

Purpose: The traditional surgical treatment for operable breast cancer larger than 3 cm is mastectomy. In order to avoid mutilating surgery, we administered primary chemotherapy to 80 patients with operable non metastatic large breast cancer T2 > 3 cm and T3, NO-N1. The purpose o f the study was to evaluate the breast-conserving rate induced by this treatment strategy and determine if it is a safe alternative for wome n with locally advanced breast carcinomas that are responders to an in duction chemotherapy. Methods and Materials: The mean age was 50.1 yea rs. Forty-three patients were T2 > 3 cm, 37 were T3. Twenty-six were N O and 54 were Nl. Mean tumor size was 5.4 cm. Patients were treated wi th three courses of the MVCF regimen (Mitoxantrone, Vindesin, Cyclopho sphamide, and 5 Fluorouracil) every 4 weeks and then with a radiosurgi cal combination. Results: The overall response rate to induction chemo therapy was 51% with 17.5% complete tumor regression. Twenty-one perce nt of the patients developed grade 3 or 4 chemotherapy toxic effects, all acceptable and reversible. Breast-conserving treatment was feasibl e in 42.5% (34/80). Twenty patients (25%) were treated with a radiosur gical combination (tumorectomy + radiation therapy), 14 (17.5%) with r adiotherapy alone (external irradiation and brachytherapy). Age, tumor stage, histology, hormonal status, hormonal receptors rate had no inf luence on the frequency of the observed regressions. Isolated recurren ces occurred in five patients, two conservatively treated and three tr eated with mastectomy. Metastatic relapses were observed in 20 patient s (12% in the responders and 38.5% in the non responders to chemothera py) (p < 0.02). Five-year actuarial survival was 73% and was significa ntly better for responders to the induction treatment. Conclusion: The se results suggest that primary chemotherapy and radiosurgical breast conserving treatment is a safe alternative to mastectomy for patients with locally advanced operable breast cancer. The long-term benefit of this strategy must be evaluated in well designed controlled trials.