Selection of local therapy after neoadjuvant chemotherapy in patients with stage IIIA,B breast cancer |
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| Authors: | David N. Danforth Jr. MD JoAnne Zujewski MD Joyce O'Shaughnessy MD David Riseberg MD Seth M. Steinberg PhD Nanette McAtee RN Marianne Noone RN Catherine Chow MD Usha Chaudhry MD Marc Lippman MD Joan Jacobson MD Paul Okunieff MD Kenneth H. Cowan MD PhD |
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| Affiliation: | (1) Surgery Branch, NCI, Building 10, Room 2B38, 20892 Bethesda, MD, USA;(2) Medicine, National Cancer Institute, USA;(3) Radiation Oncology, National Cancer Institute, USA;(4) Branches, and the Biostatistics and Data Management Section, National Cancer Institute, USA;(5) Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland;(6) Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland |
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| Abstract: | ![]()
Background: Stage IIIA,B breast cancer is commonly treated with neoadjuvant chemotherapy because of high objective response rates and improved operability. Criteria for subsequent selection of local therapy—mastectomy, radiotherapy, or both—are not well defined. We adopted a policy of selective local therapy based on rebiopsy of the breast and clinical axillary lymph node status at the time of best response to chemotherapy. Methods: Between 1980 and 1993, 126 patients with stage IIIA,B breast cancer were treated with neoadjuvant chemotherapy and definitive local therapy. The long-term incidence of locoregional failure (in-breast, chest wall, axilla, supraclavicular, neck), relapse-free survival, and overall survival was determined. Results: The overall clinical objective response rate to chemotherapy was 95.2%. Eighty-three patients underwent mastectomy, with negative margins achieved in 91.6%. Forty-two patients had breast preservation; the overall in-breast recurrence rate was 19.0% (8 of 42 patients). The overall locoregional recurrence rate by site was: chest wall—8.7% (11 of 126 patients), axilla—8.7% (11 of 126 patients), supraclavicular—5.6% (7 of 126 patients), and neck—4.0% (5 of 126 patients). The axillary recurrence rate was 6.6% (5 of 76 patients) for clinically negative axilla treated with radiotherapy only, and 12.0% (6 of 50 patients) for clinically positive axilla treated with surgery only. The overall long-term survival probabilities (6 years) according to stage were: stage IIIA—58.0%, stage IIIBnoninflam—58.0%, stage IIIBinflam—36.0%. Conclusions: These findings support a selective approach to local therapy in patients with stage IIIA,B breast cancer. This approach provides local control in most patients, and allows for breast preservation and elimination of axillary dissection in selected patients. Presented at the 49th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996. |
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| Keywords: | Neoadjuvant chemotherapy Stage III breast cancer Breast radiotherapy Mastectomy Inflammatory breast cancer |
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