PRIMARY CHEMOTHERAPY AND RADIATION-THERAPY FOR LOCALLY ADVANCED-CARCINOMA OF THE BREAST - 15 YEARS OF EXPERIENCE

The data on 91 patients (aged 30-78 years) with inoperable locally adv anced breast cancer treated by primary chemotherapy and radiation ther apy from 1980 to 1995 in the Breast Oncology Unit, Cardiff were analys ed, Four chemotherapy regimens were used: 1) doxorubicin 40 mg/m(2) vincristine 1 mg/m(2)(AV),three cycles; 2) mitozantrone 14 mg/m(2) (MZ ), three cycles; 3) cyclophosphamide 600 mg/m(2), methotrexate 40 mg/m (2), 5-fluorouracil 600 mg/m(2) (CMF), six cycles; 4)cyclophosphamide 600 mg/m(2), adriamycin/epirubicin 50mg/m(2), 5-fluorouracil 600 mg/m( 2) (CAF/CEF), six cycles. The breast and glandular areas were irradiat ed to 40-50 Cy in 15-25 fraction (+/-5-10 Gy boost in two-to-five frac tions. The overall response rate to chemotherapy was 61% (95% confiden ce interval 51-71%)with 13% CR (6-20%). Thirteen patients underwent ma stectomy for operable persistent disease. Ten patients had uncontrolle d inoperable local disease after primary therapy; 61 patients have rel apsed, 69% due to metastases, (15% synchronous with local relapse): 31 % local failure only. The overall 2-, 5- and 10-year survival rates ar e 54% (42-66%), 28%(16-40%) and 11% (1-21%) respectively. These result s confirm that metastasis rather than local failure dictates the poor outcome in these patients and that breast conservation fan be achieved .