Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: Aunicentre randomized trial with a 124-month median follow-up

Background. Neoadjuvant chemotherapy improves overall survival and renders possible breast-conserving treatment in locally advanced breast cancer. It was necessary for this method to be evaluated in operable breast tumors too large to be treated immediately by conserving surgery. Initial results of this randomized trial were published in Annals of Oncology (1991). Patients ann methods: Women with T2 > 3 cm or T3 N0-1 MO breast tumors were treated by either initial mastectomy followed by adjuvant chemotherapy, or neoadjuvant chemotherapy followed by adjusted locoregional treatment. Chem otherapy was the same in the two arms. The prognostic and predictive factor s of response to chemotherapy were analyzed. Results. Conserving treatments were performed in 63% at the end of neoadjuv ant chemotherapy and this rate had decreased to 45% at the median follow-up of 124 months. Survivals are identical in the two treatment groups. Initia l clinical tumor size <40 mm, IHC-ER <10% and Mibl >40% are predictive of t umor response to chemotherapy by uni- and multivariate analyses. For outcom e prediction, c-erb-B2 > 0% is the independent prognostic factor for overal l and metastasis-free survivals. Conclusion. Breast-conserving therapy can be performed in more than half of all cases without alteration of survival, despite a non-negligible rate of local recurrences.