CONSERVATION TREATMENT INTENSIFIED WITH TAMOXIFEN AND CAF CHEMOTHERAPY FOR SUBAREOLAR BREAST CANCERS

Formerly, patients with subareolar breast cancers have not been good c andidates for breast-conservation treatment (BCT) in Japan. However, r ecently it was reported that patients with subareolar cancers were goo d candidates for this treatment. In order to improve both cosmetic res ults and survival rates, we performed BCT for 27 patients with subareo lar breast cancers following pre-operative CAF chemotherapy and tamoxi fen administration. From August 1989 to June 1998, we performed BCT fo r 200 out of 206 patients who visited our hospital with the desire of breast-conservation. Of these patients, 27 presented with tumors withi n 2 cm of the nipple areolar complex. For 26 of these 27 patients, bre ast-conserving surgery was performed following two to four times of CA F chemotherapy, and another one patient did not undertake any surgical resection. Following the surgery, patients were treated with radiatio n therapy to the intact breast and ipsilateral axilla to a total dose of 4,400 cGy with electron conedown to a total dose of 5,300 cGy. Thei r primary tumors were at T4bN0 in 1 case, T2N1b in 5 cases, T2N0 in 18 cases, and T1cN0 in 3 cases. Tamoxifen was administered to all the pa tients. CAF chemotherapy was performed six times for stage I patients, and eight times for stage II patients in total. For one patient with direct tumor invasion to the nipple, intraarterial infusion chemothera py was performed following radiation therapy and CAF chemotherapy, wit hout any surgical resection. For another 26 patients, breast-conservin g surgery was performed, and 5 of them underwent lumpectomy under loca l anesthesia on an outpatient basis. For these 26 patients, the micros copic surgical margin was positive for 8 patients, close for 6 patient s; negative for 10 patients, and unknown for 2 patients. All patients are alive with no evidence of disease after a follow-up of approximate ly 47 months on average, and all of their cosmetic results are estimat ed as excellent or good. It is concluded that BCT intensified with pre operative CAF chemotherapy and tamoxifen for subareolar breast cancers is a satisfying treatment modality in terms of both cosmetic results and survival rates.