title: A pilot evaluation of alternating preoperative chemotherapy in the management of patients with locoregionally advanced breast carcinoma.
abstract: BACKGROUND
  This prospective trial was conducted to evaluate the outcome of patients treated with preoperative and post operative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma.
  
  
  METHODS
  Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor-positive tumors, was used after mastectomy. Post-operative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence.
  
  
  RESULTS
  Although 5 patients (7%) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65%). Sixty-eight patients (96%) underwent mastectomy. With a median follow-up of 52 months, the relapse-free and overall survival rates at 5 years were 42% and 57% respectively. Locoregional tumor recurrence occurred in 14 patients (20%), and 28 patients (39%) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome.
  
  
  CONCLUSIONS
  Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse-free and overall survival estimates for the approach described herein compared favorably with other comtemporary reports for this condition.
authors.affiliation: Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Pisansky
authors.forename: C L
authors.initials: CL
authors.lastname: Loprinzi
authors.forename: S S
authors.initials: SS
authors.lastname: Cha
authors.forename: R J
authors.initials: RJ
authors.lastname: Fitzgibbons
authors.forename: C S
authors.initials: CS
authors.lastname: Grant
authors.forename: A C
authors.initials: AC
authors.lastname: Hass
authors.forename: N F
authors.initials: NF
authors.lastname: Reuter
authors.forename: L E
authors.initials: LE
authors.lastname: Wold
authors.forename: J N
authors.initials: JN
authors.lastname: Ingle
authors.forename: C G
authors.initials: CG
authors.lastname: Kardinal
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D002277:Carcinoma / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010865:Pilot Projects; D011446:Prospective Studies; D016019:Survival Analysis