title: Extending the indications for breast-conserving treatment to patients with locally advanced breast cancer.
abstract: OBJECTIVE
  Breast-conserving therapy (BCS) has generally been limited to T1 and T2 lesions because it has been thought impossible to achieve good local control with satisfactory cosmesis in patients with more advanced disease. However, many patients with T3 and T4 lesions will exhibit dramatic tumor downstaging with neoadjuvant chemotherapy. It is our hypothesis that for these patients BCS can be performed with good local control and cosmesis.
  
  
  METHODS
  Between February 1991 and November 1995, 34 patients with T3/T4, N0-N2, M0 breast cancer completed treatment consisting of 90 mg/m2 of doxorubicin every 21 weeks x 4, surgery (a local excision if sufficiently downstaged, or mastectomy if not), high dose cyclophosphamide (CMF) every 2 weeks x 4, and radiation therapy. Radionuclide ventriculograms were performed on all patients pre- and postdoxorubicin, and at 6-12 months post radiation therapy. Patients were evaluated for toxicity, local control, cosmesis, disease-free and overall survival.
  
  
  RESULTS
  Median follow-up is 30 months. 15/34 (44%) patients underwent BCS with only one local-regional failure and actuarial 3-year disease-free and overall survival of 77% and 88%. Cosmetic results were good to excellent in 80% of the patients. Left ventricular ejection fraction, which predictably declined following doxorubicin, did not further decline after radiation therapy.
  
  
  CONCLUSIONS
  These results suggest that with this regimen a subset of patients with locally advanced breast cancer can preserve their breast with acceptable cosmesis without compromising local control or survival.
authors.affiliation: Department of Radiation Oncology, UNC School of Medicine, University of North Carolina-Chapel Hill, 27599, USA.
authors.forename: J
authors.initials: J
authors.lastname: Clark
authors.forename: J
authors.initials: J
authors.lastname: Rosenman
authors.forename: W
authors.initials: W
authors.lastname: Cance
authors.forename: J
authors.initials: J
authors.lastname: Halle
authors.forename: M
authors.initials: M
authors.lastname: Graham
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D010349:Patient Compliance
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D003520:Cyclophosphamide