PREOPERATIVE CHEMOTHERAPY FOR LOCALLY ADVANCED BREAST-CARCINOMA AT CHARITY HOSPITAL, NEW-ORLEANS, LOUISIANA

Despite increased screening and public education efforts, there contin ues to be a subset of patients with breast carcinoma who do not seek m edical attention until their lesions are locally advanced. Recently, t here has been increasing interest in administering preoperative chemot herapy to these patients. The purpose of this study was to evaluate th e Charity Hospital experience with preoperative chemotherapy for local ly advanced breast carcinoma. Thirty-three poor urban women with T-3 o r T-4 breast lesions were treated with preoperative chemotherapy befor e surgical resection, between 1987 and 1995. Their charts and patholog y were reviewed and analyzed. Local treatment was in the form of radic al mastectomy (n = 3), modified radical mastectomy (n = 26), or lumpec tomy with axillary dissection (n = 4). After preoperative chemotherapy , 4 patients had a complete histologic response (12%), 19 had a partia l response (58%), and 10 had no response (30%). After a mean follow-up of 40.6 months, stage IIIA (n = 16) and stage IIIB (n = 12) patients were found to have 5-year survival rates of 50.2 and 26.7 per cent, re spectively. Stage IV (n = 5) patients had a median survival of 23.1 mo nths with no survivors at 3 years. Patients who had a complete or part ial response to chemotherapy had a median survival of 43.0 months vers us 23.1 months for the nonresponders. We conclude that our response ra te, for poor urban women with locally advanced breast carcinoma, to pr eoperative chemotherapy, is comparable with that found in the literatu re. Furthermore, the initial response to this chemotherapy may be an i mportant indicator of ultimate prognosis.