62 Neoadjuvant chemotherapy for stage III primary breast cancer

Neoadjuvant chemotherapy is showing promising results in the primary treatment of breast cancer. We have analysed the data on 91 patients (age 30–78 years) representing 15 years of experience firm 1980–1995 in our unit. All patients had advanced tumours, 69% being T4 (46% of these inflammatory), with 76% of tumours more than 5 cm in size and 68% clinically node positive at diagnosis. Four chemotherapy regimens have been used: (1) Ariamycin 40 mg/m2 + Vincristine 1 mg/m3 × 3 cycles. (2) Mitozanstrone 14 mg/m2 × 3 cycles. (3) Cyclophosphemide 500–600 mg/m2, Methotrexate 40–50 mg/m2, 5 Fluorouracil 500–600 mg/m2 (CMF) × 3–6 cycles. (4) Cyclophosphamide 500–600 mg/m2, Adriamycin/Epirubicin 40–50 mg/m2, 5 Fluorcuracil 500–600 mg/m2 (CAF/CEF) × 3–6 cycles. The breast and glandular areas were irradiated with 40–50 Gy in 15–25 fractions ± 5–10 Gy boost in 2–5 fractions. The overall 2, 5 and 10 year actuarial survival rates are 54%, 28% and 11% respectively. Overall response rates to chemotherapy were 61% (14% CR). Response rates were highest [92% (50% CR)] with CAF/CEF based regimens. The addition of radiotherapy increased the response rate to 93% overall, and with CAF/CEF there was a 75% CR rate. The median time to maximum clinical response was 5 months and 9 months on radiological criteria. Sixty-one patients have relapsed, 54% due to metastases, 15% synchronous local and metastatic disease, 31% local failure only. Thirty-one percent of patients had mastectomy, with only 10% of patients having uncontrolled inoperable local disease after therapy.