title: Integration of full-dose adjuvant chemotherapy with definitive radiotherapy for primary breast cancer: four-year update.
abstract: Controversy exists over the effect of definitive radiotherapy on the ability to administer full doses of adjuvant chemotherapy in primary breast cancer. Ninety-six consecutive women with clinical stage I and II breast cancer were treated with radiotherapy plus chemotherapy. Three combinations of drugs were used: cyclophosphamide and 5-fluorouracil (CF); cyclophosphamide, methotrexate, and 5-fluorouracil (CMF); or cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone (CMFP). Chemotherapy consisted of two cycles of CF (cyclophosphamide at a dosage of 100 mg/m2 orally on days 1-14+5-fluorouracil at 600 mg/m2 iv on days 1 and 8) during concurrent radiotherapy, followed by six cycles of CMFP (same CF dosages+methotrexate at 40 mg/m2 iv on days 1 and 8+prednisone at 40 mg/m2 orally on days 1-14). The study included 63 premenopausal and 33 postmenopausal patients; 72 had 1-3 positive nodes, had greater than or equal to 4 positive nodes, and 9 had negative nodes and negative estrogen receptors. The mean CF doses delivered during concurrent radiotherapy were 95% of the optimal doses, and the mean CMF doses administered during the six cycles after radiotherapy were 89%. The CMF was delivered at level I (greater than or equal to 85% of optimal doses) to 73% of the patients. With a median follow-up of 36 months, 16 relapses have been observed. Two of these patients had treatment failure only in the breast or axilla and are disease free after mastectomy. Of the 72 patients with 1-3 positive nodes, 10 relapsed in distant sites, while 4 of 15 patients with greater than or equal to 4 positive nodes have had distant failure.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Hematology-Oncology Section, University of Pennsylvania Cancer Center, Hospital of the University of Pennsylvania, Philadelphia 19104.
authors.forename: J H
authors.initials: JH
authors.lastname: Glick
authors.forename: B L
authors.initials: BL
authors.lastname: Fowble
authors.forename: D G
authors.initials: DG
authors.lastname: Haller
authors.forename: E F
authors.initials: EF
authors.lastname: Rosato
authors.forename: J A
authors.initials: JA
authors.lastname: Mackie
authors.forename: C
authors.initials: C
authors.lastname: Weiler
authors.forename: D J
authors.initials: DJ
authors.lastname: Glover
authors.forename: K R
authors.initials: KR
authors.lastname: Fox
authors.forename: S
authors.initials: S
authors.lastname: Hurwitz
authors.forename: R L
authors.initials: RL
authors.lastname: Goodman
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D011241:Prednisone / Q000627:therapeutic use
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D011241:Prednisone; D008727:Methotrexate