title: Breast conservation and prolonged chemotherapy for locally advanced breast cancer: the University of Michigan experience.
abstract: OBJECTIVE
  To determine whether breast conservation and prolonged neoadjuvant chemotherapy have efficacy in locally advanced breast cancer (LABC), as measured by survival and rate of breast conservation.
  
  
  METHODS
  Eighty-nine patients with stage III disease were enrolled at the University of Michigan (UM) onto a prospective nonrandomized trial. Patients received nine 21-day cycles of neoadjuvant chemohormonal therapy that consisted of doxorubicin 30 mg/m2 and cyclophosphamide 750 mg/m2 intravenously on day 1, conjugated estrogens 0.625 mg orally twice daily on days 6 to 8, methotrexate 40 mg/m2 and fluorouracil 500 mg/m2 intravenously on day 8, and tamoxifen 10 mg orally twice daily on days 9 to 14. Patients with a negative biopsy received radiation only, while those with residual disease underwent mastectomy and postoperative radiotherapy. Eight more cycles of chemohormonal therapy were administered after local-regional therapy.
  
  
  RESULTS
  The clinical 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%, respectively. The median disease-free survival time was 2.4 years. The 5-year actuarial rates of local-regional control with local failure as only first failure were 82% and 78% following radiotherapy, and mastectomy and radiotherapy, respectively (P = .99).
  
  
  CONCLUSIONS
  Prolonged neoadjuvant chemohormonal therapy and biopsy-driven local therapy have efficacy in LABC, with 28% of patients being candidates for breast conservation and a 5-year overall survival rate of 54%.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0680, USA. smerajve@umich.edu
authors.forename: S D
authors.initials: SD
authors.lastname: Merajver
authors.forename: B L
authors.initials: BL
authors.lastname: Weber
authors.forename: R
authors.initials: R
authors.lastname: Cody
authors.forename: D
authors.initials: D
authors.lastname: Zhang
authors.forename: M
authors.initials: M
authors.lastname: Strawderman
authors.forename: K A
authors.initials: KA
authors.lastname: Calzone
authors.forename: V
authors.initials: V
authors.lastname: LeClaire
authors.forename: A
authors.initials: A
authors.lastname: Levin
authors.forename: J
authors.initials: J
authors.lastname: Irani
authors.forename: M
authors.initials: M
authors.lastname: Halvie
authors.forename: D
authors.initials: D
authors.lastname: August
authors.forename: M
authors.initials: M
authors.lastname: Wicha
authors.forename: A
authors.initials: A
authors.lastname: Lichter
authors.forename: L J
authors.initials: LJ
authors.lastname: Pierce
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate