Preoperative paclitaxel and radiotherapy for locally advanced breast cancer: Surgical aspects

Introduction: Approximately 15% of breast cancer patients present with larg e tumors that involve the skin, the chest wall, or the regional lymph nodes . Multimodality therapy is required, to provide the best chance for long-te rm survival. We have developed a regimen of paclitaxel, with concomitant ra diation, as a primary therapy in patients with locally advanced breast canc er. Methods: Eligible patients had locally advanced breast cancer (stage IIB or III). After obtaining informed consent, patients received paclitaxel (30 m g/m(2) during 1 hour) twice per week for 8 weeks and radiotherapy to 45 Gy (25 fractions, at 180 cGy/fraction, to the breast and regional nodes). Pati ents then underwent modified radical mastectomy followed by postoperative p olychemotherapy. Results: Twenty-nine patients were enrolled. Of these, 28 were assessable f or clinical response and toxicity, and 27 were assessable for pathological response. Objective clinical response was achieved in 89%. At the time of s urgery, 33% had no or minimal microscopic residual disease. Chemoradiation- related acute toxicity was limited; however, surgical complications occurre d in 41% of patients. Conclusions: Preoperative paclitaxel with radiotherapy is well tolerated an d provides significant pathological response, in up to 33% of patients with locally advanced breast cancer, but with a significant postoperative morbi dity rate.