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Induction (neoadjuvant) chemotherapy and breast conserving treatment for locally advanced carcinoma of the breast
Radiation Oncology, Biology, Physics
300
Volume 24, Supplement 1
MATERIALS AND METHODS: From 19661989, 133 patients with stage I or II were treated. Since 1981, 42 of 63 patients were treated with chemoradiotherapy using CHOP. Until then, patients were treated with radiation + mild chemotherapy. Median radiation doses were 40 Gy in patients with radiation alone, and of xerostomia. changes of complaints and 30 Gy with chemoradiotherapy . In order to score the severity Nine questionaires indicating xerostomia such as requireing water habitual activities were investigated. for drinking water, etc. were used. during eating, bringing water when leaving home, awakening RESULTS: Five-year survival rates were 45% for patients treated until 1980 (n=701, and 78% for freedom from relapse(FFR1 rates were 42% and 768, patients treated thereafter (n=63l(p
1104 INDUCTION (NEOADJUVANT) CHEMOTHERAPY AND BREAST LOCALLY ADVANCED CARCINOMA OF THE BREAST.
CONSERVING
TREATMENT
FOR
Christine A. Birchansky, M.D., Gordon F. Schwartz, M.D., Lydia T. Komamicky, M.D., Ronald I. Cantor, M.D., William A. Biermann, M.D., Frederick M. Fellin, M.D., Jennifer L. Adams, Carl M. Mansfield, M.D.
Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107 Purpose: To determine if induction chemotherapy followed by breast conserving surgery and radiation is a viable treatment option to mastectomy for locally advanced carcinoma of the breast. Materials and Methods: From 1983 to 1991, 48 women with biopsy-proven
stages IIB and III breast carcinoma from a single surgical practice (GFS) were treated with Ch4P induction chemotherapy. When a plateau of response was achieved, breast conserving surgery, including lumpectomy and axillary dissection, was performed. This was followed by radiation and more chemotherapy (total of 12 cycles). Response to chemotherapy, local control, overall survival, disease-free survival, and cosmesis were assessed. Results: Of the 40 evaluable patients, 4 (10%) primary tumors had a complete clinical response following chemotherapy, 82% had a partial response, and 8% had no response. Thirty-four patients had palpable axillary nodes; of these, 29% had a complete clinical response, 65% had a partial response, and 6% had no response. Following lumpectomy, 2 of the 4 primary tumors with a complete clinical response had no evidence of residual tumor. Local control was achieved in 96.6%. Follow-up ranges from 1 to 8 years, with a median of 30 months. Projected 2 and 5 year overall survivals were both 87.4%. Disease-free 2 and 5 year survivals were 86.5% and 78.8%, respectively. The majority of patients did not require a treatment break from radiotherapy. However, most patients needed some dose adjustment in chemotherapy due to hematologic toxicity. Good to excellent cosmesis was achieved in most patients. Conclusion: Locally advanced breast cancer has been associated with a dismal prognosis, with about 20% of patients remaining disease-free at 2 years. Women with stages IIB and III carcinoma of the breast who respond to induction chemotherapy can be treated with breast conserving surgery and radiation therapy with improved outcome and appearance compared to those treated traditionally by mastectomy or radiation.
1105 BREAST CELL-
AFTER CONSERVATIVE SURGERY AND RADIATION THERAPY
John Rescigno, MD l, Bcryl McCormick MD l, Louise Cox RN 2, and Arthur Brown MD 3 Depts of lRadiati~~ oncology, A,
and %nfectious Disease+Memorial Sloan-Kettering Cancer Center
purposed: The occurrence of ipsilateral breast cellulitis after conservative surgery and radiation therapy (RT) has been underreported in the literature. In our recent experience with post-RT breast and arm cellulitis we identify potential clinical correlates associated with an increased risk of infection. The clinical course of these patients is described as well.
300
Volume 24, Supplement 1
MATERIALS AND METHODS: From 19661989, 133 patients with stage I or II were treated. Since 1981, 42 of 63 patients were treated with chemoradiotherapy using CHOP. Until then, patients were treated with radiation + mild chemotherapy. Median radiation doses were 40 Gy in patients with radiation alone, and of xerostomia. changes of complaints and 30 Gy with chemoradiotherapy . In order to score the severity Nine questionaires indicating xerostomia such as requireing water habitual activities were investigated. for drinking water, etc. were used. during eating, bringing water when leaving home, awakening RESULTS: Five-year survival rates were 45% for patients treated until 1980 (n=701, and 78% for freedom from relapse(FFR1 rates were 42% and 768, patients treated thereafter (n=63l(p
1104 INDUCTION (NEOADJUVANT) CHEMOTHERAPY AND BREAST LOCALLY ADVANCED CARCINOMA OF THE BREAST.
CONSERVING
TREATMENT
FOR
Christine A. Birchansky, M.D., Gordon F. Schwartz, M.D., Lydia T. Komamicky, M.D., Ronald I. Cantor, M.D., William A. Biermann, M.D., Frederick M. Fellin, M.D., Jennifer L. Adams, Carl M. Mansfield, M.D.
Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107 Purpose: To determine if induction chemotherapy followed by breast conserving surgery and radiation is a viable treatment option to mastectomy for locally advanced carcinoma of the breast. Materials and Methods: From 1983 to 1991, 48 women with biopsy-proven
stages IIB and III breast carcinoma from a single surgical practice (GFS) were treated with Ch4P induction chemotherapy. When a plateau of response was achieved, breast conserving surgery, including lumpectomy and axillary dissection, was performed. This was followed by radiation and more chemotherapy (total of 12 cycles). Response to chemotherapy, local control, overall survival, disease-free survival, and cosmesis were assessed. Results: Of the 40 evaluable patients, 4 (10%) primary tumors had a complete clinical response following chemotherapy, 82% had a partial response, and 8% had no response. Thirty-four patients had palpable axillary nodes; of these, 29% had a complete clinical response, 65% had a partial response, and 6% had no response. Following lumpectomy, 2 of the 4 primary tumors with a complete clinical response had no evidence of residual tumor. Local control was achieved in 96.6%. Follow-up ranges from 1 to 8 years, with a median of 30 months. Projected 2 and 5 year overall survivals were both 87.4%. Disease-free 2 and 5 year survivals were 86.5% and 78.8%, respectively. The majority of patients did not require a treatment break from radiotherapy. However, most patients needed some dose adjustment in chemotherapy due to hematologic toxicity. Good to excellent cosmesis was achieved in most patients. Conclusion: Locally advanced breast cancer has been associated with a dismal prognosis, with about 20% of patients remaining disease-free at 2 years. Women with stages IIB and III carcinoma of the breast who respond to induction chemotherapy can be treated with breast conserving surgery and radiation therapy with improved outcome and appearance compared to those treated traditionally by mastectomy or radiation.
1105 BREAST CELL-
AFTER CONSERVATIVE SURGERY AND RADIATION THERAPY
John Rescigno, MD l, Bcryl McCormick MD l, Louise Cox RN 2, and Arthur Brown MD 3 Depts of lRadiati~~ oncology, A,
and %nfectious Disease+Memorial Sloan-Kettering Cancer Center
purposed: The occurrence of ipsilateral breast cellulitis after conservative surgery and radiation therapy (RT) has been underreported in the literature. In our recent experience with post-RT breast and arm cellulitis we identify potential clinical correlates associated with an increased risk of infection. The clinical course of these patients is described as well.