title: Primary systemic therapy for operable breast cancer.
abstract: Eighty-eight patients presenting with operable breast cancer of 4 cm or greater in diameter (T2, T3, N0, N1, M0) have received primary systemic therapy. Response was assessed following 12 weeks of systemic therapy by linear regression analysis of changes in tumour volume. Definitive locoregional surgery (mastectomy n = 82, wide local excision n = 6) was performed on completion of systemic therapy (3-6 months). Response was observed in 24 (39%) of the 61 patients who received endocrine therapy; all 24 had tumours with an oestrogen receptor (ER) concentration of greater than or equal to 20 fmol mb-1 cytosol protein. Cytotoxic therapy was reserved for patients with tumours of ER concentration less than 20 fmol mg-1 cytosol protein (n = 27) or when endocrine therapy had failed (n = 20). Response was observed in 34 patients (72%). The overall survival rate at 3 years was 86%, with 81% remaining free from local relapse. We propose that the treatment policy outlined in this paper should now be tested against orthodox management by controlled randomised trial.
authors.affiliation: University Department of Surgery, Royal Infirmary, Edinburgh, UK.
authors.forename: E D
authors.initials: ED
authors.lastname: Anderson
authors.forename: A P
authors.initials: AP
authors.lastname: Forrest
authors.forename: R A
authors.initials: RA
authors.lastname: Hawkins
authors.forename: T J
authors.initials: TJ
authors.lastname: Anderson
authors.forename: R C
authors.initials: RC
authors.lastname: Leonard
authors.forename: U
authors.initials: U
authors.lastname: Chetty
mesh_terms: D000328:Adult; D000368:Aged; D000616:Aminoglutethimide / Q000009:adverse effects / Q000627:therapeutic use; D000735:Androstenedione / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D047072:Aromatase Inhibitors; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D002064:Buserelin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D017273:Goserelin; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010052:Ovariectomy; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D047072:Aromatase Inhibitors; D013629:Tamoxifen; D017273:Goserelin; D000616:Aminoglutethimide; D000735:Androstenedione; C014594:formestane; D002064:Buserelin