title: Primary chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil in operable breast carcinoma.
abstract: BACKGROUND
  Primary chemotherapy (PC) is becoming an accepted practice to treat large tumors to avoid mastectomies and as a surrogate of outcome.
  
  
  METHODS
  A series of 305 patients with tumors >3 cm with T2-3N0-1M0 classification were treated with a multimodal approach that consisted of 3 courses of primary cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) followed by appropriate local treatment and 3 more courses of CMF or 4 courses of doxorubicin. Response was assessed by mammography.
  
  
  RESULTS
  The overall response rate was 48% (a 3% pathologic complete response rate). Conservative surgery was achieved in 79.64% of the patients with a low rate of local disease recurrences (5%). Toxicity was minimal. With a median follow-up of 104 months, the 8-year disease-free survival (DFS) rate was 57.63% and the 8-year overall survival (OS) was 67.65%. The DFS and OS rates for patients with a clinical response were significantly longer, i.e., 70% (P=0.0048) and 90% (P=0.0042), respectively.
  
  
  CONCLUSIONS
  PC with CMF was feasible. A high rate of breast-conservative surgery was achieved. The current results stressed the value of PC to increase conservative surgery and as a predictor of outcome.
authors.affiliation: Department of Medical Oncology, Unitat Funcional De MAMA, Institut Català d'Oncologia, Hospital Duran i Reynals, Hospital Universitari I, Universitari de Bellvitge, Barcelona, Spain. cfalo@ico.scs.es
authors.forename: Catalina
authors.initials: C
authors.lastname: Falo
authors.forename: Abelardo
authors.initials: A
authors.lastname: Moreno
authors.forename: Enrique
authors.initials: E
authors.lastname: Benito
authors.forename: Belen
authors.initials: B
authors.lastname: Lloveras
authors.forename: Mar
authors.initials: M
authors.lastname: Varela
authors.forename: Jose Ma
authors.initials: JM
authors.lastname: Serra
authors.forename: Luis
authors.initials: L
authors.lastname: Prieto
authors.forename: Diego
authors.initials: D
authors.lastname: Azpeitia
authors.forename: Agustin
authors.initials: A
authors.lastname: Escobedo
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate