OVERVIEW OF RANDOMIZED PERIOPERATIVE POLYCHEMOTHERAPY TRIALS IN WOMENWITH EARLY-STAGE BREAST-CANCER

Purpose: To determine whether perioperative polychemotherapy (PeCT) ca n significantly prolong the overall survival of women with early-stage breast cancer, Methods: A meta-analysis that used updated individual patient data from all available randomized trials of PeCT, both publis hed and unpublished, was conducted, Data on 6,093 patients (1,124 deat hs and 1,912 recurrences) from five clinical trials were available (me dian follow-vp duration, 5.3 years; maximum, 11.3 years), Results: No significant effect of PeCT on overall survival was observed, However, patients who received PeCT held a significantly longer disease-free su rvival (hazards ratio [HR], 0.89; 95% confidence interval [CI], 0.82 t o 0.98; P = .02). Time to local recurrence was significantly prolonged in the PeCT arm (HR, 0.68; 95% CI, 0.58 to 0.80; P < .0001), Likewise , there was a borderline significant difference in favor of PeCT in te rms of time to distant metastases (HR, 0.90; 95% CI, 0.81 to 1.00; P = .05), Subgroup analyses suggest that node-negative women benefited th e most from treatment, Conclusion: At present, there is no evidence th at PeCT is able to prolong overall survival in patients with early-sta ge breast cancer; however, further follow-up evaluation is required, P eCT significantly prolongs disease-free survival, especially in node-n egative women, which emphasizes once more the need for clinical trials in this subgroup. (C) 1997 by American Society of Clinical Oncology.