title: Preoperative chemotherapy for locally advanced breast carcinoma at Charity Hospital, New Orleans, Louisiana.
abstract: Despite increased screening and public education efforts, there continues to be a subset of patients with breast carcinoma who do not seek medical attention until their lesions are locally advanced. Recently, there has been increasing interest in administering preoperative chemotherapy to these patients. The purpose of this study was to evaluate the Charity Hospital experience with preoperative chemotherapy for locally advanced breast carcinoma. Thirty-three poor urban women with T3 or T4 breast lesions were treated with preoperative chemotherapy before surgical resection, between 1987 and 1995. Their charts and pathology were reviewed and analyzed. Local treatment was in the form of radical mastectomy (n = 3), modified radical mastectomy (n = 26), or lumpectomy with axillary dissection (n = 4). After preoperative chemotherapy, 4 patients had a complete histologic response (12%), 19 had a partial response (58%), and 10 had no response (30%). After a mean follow-up of 40.6 months, stage IIIA (n = 16) and stage IIIB (n = 12) patients were found to have 5-year survival rates of 50.2 and 26.7 per cent, respectively. Stage IV (n = 5) patients had a median survival of 23.1 months with no survivors at 3 years. Patients who had a complete or partial response to chemotherapy had a median survival of 43.0 months versus 23.1 months for the nonresponders. We conclude that our response rate, for poor urban women with locally advanced breast carcinoma, to preoperative chemotherapy, is comparable with that found in the literature. Furthermore, the initial response to this chemotherapy may be an important indicator of ultimate prognosis.
authors.affiliation: Department of Surgery, Stanley S. Scott Cancer Center and Louisiana State University, New Orleans, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Cummiskey
authors.forename: R
authors.initials: R
authors.lastname: Mera
authors.forename: E A
authors.initials: EA
authors.lastname: Levine
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000601:surgery; D018276:Carcinoma, Medullary / Q000188:drug therapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008145:Louisiana; D015411:Mastectomy, Modified Radical; D015409:Mastectomy, Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population