EXTENDING THE INDICATIONS FOR BREAST-CONSERVING TREATMENT TO PATIENTSWITH LOCALLY ADVANCED BREAST-CANCER

Purpose: Breast-conserving therapy (BCS) has generally been limited to T1 and T2 lesions because it has been thought impossible to achieve g ood local control with satisfactory cosmesis in patients with more adv anced disease. However, many patients with T3 and T4 lesions will exhi bit dramatic tumor downstaging with neoadjuvant chemotherapy. It is ou r hypothesis that for these patients BCS can be performed with good lo cal control and cosmesis. Methods and Materials: Between February 1991 and November 1995, 34 patients with T3/T4, N0-N2, M0 breast cancer co mpleted treatment consisting of 90 mg/m(2) of doxorubicin every 2 1/2 weeks x 4 surgery (a local excision if sufficiently downstaged, or mas tectomy if not), high dose cyclophosphamide (CMF) every 2;weeks x 4, a nd radiation therapy. Radionuclide ventriculograms were performed on a ll patients pre- and postdoxorubicin, and at 6-12 months post radiatio n therapy. Patients were evaluated for toxicity, local control, cosmes is, disease-free and overall survival. Results: Median follow-up is 30 months. 15/34 (44%) patients underwent BCS with only one local-region al failure and actuarial 3-year disease-free and overall survival of 7 7% and 88%. Cosmetic results were good to excellent in 80% of the pati ents. Left ventricular ejection fraction, which predictably declined f ollowing doxorubicin, did not further decline after radiation therapy. Conclusions: These results suggest that with this regimen a subset of patients with locally advanced breast cancer can preserve their breas t with acceptable cosmesis without compromising local control or survi val. (C) 1998 Elsevier Science Inc.