title: Neoadjuvant chemotherapy for local advanced breast cancer with stage IIIB.
abstract: In this study, we have done a retrospective evaluation of the clinical benefits of neoadjuvant chemotherapy in 25 patients with stage IIIB, locally advanced breast cancer in terms of response rate and survival benefit. Most of these patients were treated with an anthracycline-based regimen such as CAF and EC, and some were also treated sequentially with docetaxel. An overall objective response was observed in 15 patients (60%), composed of 1 patient (4%) with a complete response (CR) and 14 (56%) with a partial response (PR). No progressive disease was observed. Following neoadjuvant chemotherapy, locoregional treatment (mastectomy without partial resection) was carried out in 24 patients, 1 of whom also received radiotherapy. The rate of local recurrence in neoadjuvant chemotherapy with anthracycline-based regimens was lower than those of adjuvant chemotherapy with anthracycline-based and non-anthracycline-based regimens (10.0% versus 33.3% and 28.5%, respectively). By contrast, the rate of distant metastasis with neoadjuvant chemotherapy was higher than that seen with anthracycline-based adjuvant chemotherapy regimens (35.0% versus 11.1%, respectively), while the rate of distant metastasis in non-anthracycline-based regimens was even higher at 66.6%. The 5-year survival in the responders treated with neoadjuvant chemotherapy was better than in the non-responders (90.9% versus 50.0%; NS, P=0.28, log-rank test). The survival at 5 years in the patients treated with neoadjuvant chemotherapy was inferior to that with adjuvant anthracycline-based chemotherapy regimens (69.7% versus 77.8%), although the survival in neoadjuvant chemotherapy was better than those of non-anthracycline-based adjuvant regimen (69.7% versus 66.7%). However, at 10 years the overall survival with anthracycline-based neoadjuvant chemotherapy regimens was superior to that seen with either anthracycline or non-anthracycline-based adjuvant chemotherapy regimens. These results suggest that primary (neoadjuvant) systemic therapy with anthracycline-based regimens for locally advanced, stage IIIB, breast cancer may have a potential survival benefit when given in combination with adjuvant chemotherapy, as it will provide the best means of decreasing both local recurrence and distant metastasis.
authors.affiliation: Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Minami-ku, Hiroshima 734-8553, Japan. rkim@hiroshima-u.ac.jp
authors.forename: Ryungsa
authors.initials: R
authors.lastname: Kim
authors.forename: Akihiko
authors.initials: A
authors.lastname: Osaki
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tanabe
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Toge
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D015251:Epirubicin; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil