BREAST-CONSERVATION AND PROLONGED CHEMOTHERAPY FOR LOCALLY ADVANCED BREAST-CANCER - THE UNIVERSITY-OF-MICHIGAN EXPERIENCE

Purpose: To determine whether breast conservation and prolonged neoadj uvant chemotherapy have efficacy in locally advanced breast cancer (LA BC), as measured by survival and rate of breast conservation. Material s and Methods: Eighty-nine patients with stage III disease were enroll ed at the University of Michigan (UM) onto a prospective nonrandomized trial. Patients received nine 21-day cycles of neoadjuvant chemohormo nal therapy that consisted of doxorubicin 30 mg/m(2) and cyclophospham ide 750 mg/m(2) intravenously on day 1, conjugated estrogens 0.625 mg orally twice daily on days 6 to 8, methotrexate 40 mg/m(2) and fluorou racil 500 mg/m(2) intravenously on day 8, and tamoxifen 10 mg orally t wice daily on days 9 to 14. Patients with a negative biopsy received r adiation only, while those with residual disease underwent mastectomy and postoperative radiotherapy. Eight more cycles of chemohormonal the rapy were administered after local-regional therapy. Results: The clin ical response rate to neoadjuvant therapy was 97%, 28% of patients had a complete pathologic response evaluated at biopsy. Five-year overall and disease-free survival probabilities were 54% and 44%, respectivel y. The median disease-free survival time was 2.4 years. The 5-year act uarial rates of local-regional control with local failure as only firs t failure were 82% and 78% following radiotherapy, and mastectomy and radiotherapy, respectively (P =.99). Conclusion: Prolonged neoadjuvant chemohormonal therapy and biopsy-driven local therapy have efficacy i n LABC, with 28% of patients being candidates for breast conservation and a ti-year overall survival rate of 54%. (C) 1997 by American Socie ty of Clinical Oncology.