THE EFFICACY OF NEOADJUVANT CHEMOTHERAPY COMPARED TO POSTOPERATIVE THERAPY IN THE TREATMENT OF LOCALLY ADVANCED BREAST-CANCER

The current approach to the treatment of locally advanced breast cance r is sequential chemotherapy, surgery and/or radiation and consolidati on chemotherapy. Although significant tumor response is seen with this regimen, there are few studies that compare this approach to postoper ative chemotherapy. The purpose of this study was to compare the disea se-free and overall survival of patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and surgery to patients t reated with surgery followed by adjuvant chemotherapy. Ninety-four pat ients with stage IIB, IIIA, and IIIB breast cancer were treated with a standardized chemotherapy regimen. The first group, 60 patients who w ere followed prospectively, was treated with neoadjuvant chemotherapy (NCT) consisting of vincristine, prednisone, cytoxan, methotrexate, an d 5-FU (CVFMP) followed by surgery and consolidation chemotherapy with adriamycin. The second group, 34 patients evaluated retrospectively, had surgery followed by postoperative chemotherapy (PCT) with CVFMP fo llowed by adriamycin. Overall median follow-up was 38 months. In the N CT group, 45/60 (75%) patients had a clinical response to induction th erapy and the median reduction in tumor size was 50%. The rates of loc al recurrence, distant recurrence, and death from disease were similar in the two groups. The time to local recurrence was similar for the t wo groups. However the median time to distant recurrence was shorter i n the NCT group (19 month vs. 31 months, p = NS). Overall median survi val among the NCT patients was shorter than for the PCT group (30 vs. 47 months, p = NS). The current study suggests that postoperative ther apy is comparable to a neoadjuvant regimen in patients with locally ad vanced breast cancer with regard to local recurrence, distant recurren ce, and overall survival.