PRIMARY CHEMOTHERAPY IN BREAST-CANCER - CORRELATION BETWEEN TUMOR RESPONSE AND PATIENT OUTCOME

This study focused on the correlation between tumor response and patie nt outcome in 329 breast cancers treated with primary chemotherapy. Th ere were 141 stage IIIB tumors, including 109 inflammatory carcinomas. Other malignancies (34 IIIA, 99 IIB, 55 IIA) were operable but consid ered to be too large (> 3 cm) for conservative surgery and received pr imary chemotherapy to avoid mastectomy. All received the AVCF regimen, comprising 4-week cycles of doxorubicin (30 mg/m(2)) day 1, vincristi ne (1 mg/m(2)) day 1, 5-fluorouracil (5-FU; 400 mg/m(2)) days 2 throug h 5, cyclophosphamide (300 mg/m(2)) days 2 through 5. In 189 cases, me thotrexate (15 mg/m(2)) was added at day 2 and day 3. Patients receive d 6 cycles, then underwent locoregional treatment (surgery, radiothera py, or both) according to tumor regression. The response rate was asse ssed by clinical, mammographic, and echographic examinations: a 50% ra te of objective responses were noted, of which 15% were complete respo nses (tumor shrinkage allowed breast conservation in 68% of patients w ho had stages II or IIIA). For the whole population studied, median fo llow-up was 111 months (range, 60-196). One hundred fifty-seven patien ts had disease relapse (48 local, 14 contralateral, 95 distant). Kapla n-Meier estimates showed an increased 10-year overall survival for pat ients in complete response, as compared with noncomplete response: 70% versus 50% (p < 0.03). Complete response to neoadjuvant chemotherapy seems a good prognostic factor.