title: Preoperative paclitaxel and radiotherapy for locally advanced breast cancer: surgical aspects.
abstract: BACKGROUND
  Approximately 15% of breast cancer patients present with large tumors that involve the skin, the chest wall, or the regional lymph nodes. Multimodality therapy is required, to provide the best chance for long-term survival. We have developed a regimen of paclitaxel, with concomitant radiation, as a primary therapy in patients with locally advanced breast cancer.
  
  
  METHODS
  Eligible patients had locally advanced breast cancer (stage IIB or III). After obtaining informed consent, patients received paclitaxel (30 mg/m2 during 1 hour) twice per week for 8 weeks and radiotherapy to 45 Gy (25 fractions, at 180 cGy/fraction, to the breast and regional nodes). Patients then underwent modified radical mastectomy followed by postoperative polychemotherapy.
  
  
  RESULTS
  Twenty-nine patients were enrolled. Of these, 28 were assessable for clinical response and toxicity, and 27 were assessable for pathological response. Objective clinical response was achieved in 89%. At the time of surgery, 33% had no or minimal microscopic residual disease. Chemoradiation-related acute toxicity was limited; however, surgical complications occurred in 41% of patients.
  
  
  CONCLUSIONS
  Preoperative paclitaxel with radiotherapy is well tolerated and provides significant pathological response, in up to 33% of patients with locally advanced breast cancer, but with a significant postoperative morbidity rate.
authors.affiliation: Department of Surgery, Kenneth Norris Comprehensive Cancer Center, and the University of Southern California, Los Angeles 90033, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Skinner
authors.forename: H
authors.initials: H
authors.lastname: Silberman
authors.forename: B
authors.initials: B
authors.lastname: Florentine
authors.forename: T J
authors.initials: TJ
authors.lastname: Lomis
authors.forename: F
authors.initials: F
authors.lastname: Corso
authors.forename: D
authors.initials: D
authors.lastname: Spicer
authors.forename: S C
authors.initials: SC
authors.lastname: Formenti
mesh_terms: D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel