Locally advanced breast cancer in the elderly: a major challenge requiring effective and appropriate treatment

AIMS AND BACKGROUND: Breast cancer is the most common tumor in women. As the population above 65 years increases, breast cancer will be a more substantial problem for elderly patients. This work reports our experience in the management of stage III and IV locally advanced breast cancer. METHODS: Nineteen patients over 65 years of age (mean, 70.3 years) with stage III and IV breast cancers, treated between 1990 and 2000, are considered. The management and outcome are evaluated. RESULTS: Nine patients had stage IIIA breast cancer, 7 stage IIIB and 3 stage IV. Sixteen underwent Madden mastectomy and 3 simple mastectomy. Patients at stage IIIB and 1 patient at stage IV with T4 tumor received neo-adjuvant chemotherapy. There were no significant postoperative complications. Sixteen patients were given tamoxifen and 10 patients adjuvant chemotherapy. Patients were followed for a median of 36.7 months (range, 6-72 months). In 8 patients with stage IlIl disease, metastasis developed. Two patients had local recurrence of disease. Of the patients at stage IIIA, 6 were free from disease (one died from unrelated causes) and 3 had recurrent disease (2 died). Of the patients at stage IIIB, 2 are disease free and 5 had recurrent disease and died. Of the patients at stage IV, only one is alive. CONCLUSIONS: Stage and individual characteristics of elderly women influence management. Patients should be managed adequately since most of them are fit enough to undergo treatment.     

Neoadjuvant chemotherapy with taxotere-epirubicin-5-fluorouracil (TEF) in local-regionally advanced breast cancer: a preliminary report

AIMS AND BACKGROUND: Sixty-three patients with local-regionally advanced breast cancer were treated with neoadjuvant chemotherapy consisting of docetaxel (Taxotere), epirubicin, and 5-fluorouracil (TEF). METHODS AND STUDY DESIGN: Preoperatively, patients received four cycles of Taxotere (80 mg/m2), epirubicin (60 mg/m2), and 5-fluorouracil (500 mg/m2), repeated every 21 days. Following completion of four cycles of chemotherapy, appropriate surgery was performed. After the surgery, patients received one cycle of the TEF chemotherapy regimen; following chemotherapy, radiotherapy was applied, and at the end two more cycles of TEF chemotherapy regimen were given. RESULTS: Sixty-three patients with locally advanced breast cancer were treated. Three patients were excluded from the study before the evaluation of response. Median age of the patients was 50 years (range, 25-77). Twenty-seven and 33 patients were premenopausal and postmenopausal, respectively. Thirty-nine patients were in stage IIIA and 21 in stage IIIB. Complete and partial responses were observed in 15 (25%) and 42 (70%) of the patients following four cycles of preoperative TEF chemotherapy regimen, respectively. Overall response was 95%, and primary lesion progressed only in 3 (5%) patients. The mean disease-free survival was 15.9 +/- 6.8 (range, 3.5-28) months and the mean overall survival was 18.6 +/- 7.2 (range, 5-30) months. The most frequent side effects were nausea-vomiting, mucositis, alopecia and leukopenia. CONCLUSIONS: TEF therapy is a treatment with a high overall response rate and toxicities similar to other taxotere combinations. A longer follow-up of patients is necessary for the determination of disease-free survival and overall survival.     

Outcomes of high-dose chemotherapy and autologous stem-cell transplantation in stage IIIB inflammatory breast cancer.

PURPOSE: To evaluate the disease-free survival (DFS) and overall survival (OS), prognostic factors, and treatment-related mortality of women with stage IIIB inflammatory breast cancer (IBC) treated with combined modality therapy (CMT) and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation. PATIENTS AND METHODS: Between 1989 and 1997, 47 consecutive patients with stage IIIB IBC were treated with CMT and HDCT and were the subject of this retrospective analysis. Chemotherapy was administered to all patients before and/or after definitive surgery. Neoadjuvant and adjuvant chemotherapy was administered to 33 and 34 patients, respectively, and 20 patients received both. All patients received HDCT with autologous stem-cell transplantation, and 41 patients received locoregional radiation therapy. Tamoxifen was prescribed to patients with estrogen receptor (ER)-positive cancer. RESULTS: The mean duration of follow-up from diagnosis was 30 months (range, 6 to 91 months) and from HDCT was 22 months (range, 0.5 to 82 months). At 30 months, the Kaplan-Meier estimates of DFS and OS from diagnosis were 57.7% and 59.1%, respectively. At 4 years, the Kaplan-Meier estimates of DFS and OS from diagnosis were 51.3% and 51.7%, respectively. In a multivariate analysis, the only factors associated with better survival were favorable response to neoadjuvant chemotherapy (P =.04) and receipt of tamoxifen (P =.06); however, the benefit of tamoxifen was only demonstrated in patients with ER-positive breast cancer. At last follow-up, 28 patients (59. 6%) were alive and disease-free. Seventeen patients (36.2%) developed recurrent breast cancer. Seventeen patients died: 15 from disease recurrence and two (4.2%) from treatment-related mortality due to HDCT. CONCLUSION: In this analysis, the early results of treatment with CMT and HDCT compare favorably with other series of patients with stage IIIB IBC treated with CMT alone. These outcomes must be confirmed with longer follow-up and controlled studies.     

口服氟铁龙联合环磷酰胺治疗晚期乳腺癌

目的 观察口服氟铁龙和环磷酰胺联合方案治疗晚期乳腺癌的疗效与安全性。方法 2000年6月-2002年6月口服氟铁龙和环磷酰胺联合方案治疗晚期乳腺癌83例。平均化疗5个周期,中位数6个周期(2．6个周期)。结果 完全缓解4例,部分缓解34例,稳定33例,进展12例,总有效率(CR PR)45．8％,中位肿瘤进展时间6个月。主要毒性为恶心和呕吐,Ⅲ度恶心和呕吐发生率为2．4％(2／83),未发生Ⅳ度胃肠道反应。骨髓抑制轻微。结论 口服氟铁龙和环磷酰胺联合方案治疗晚期乳腺癌疗效较好,使用方便,毒性反应轻,足治疗晚期乳腺癌的较好方案。     

Short-Term Intermittent Intravenous Clodronate in the Prevention of Bone Loss Related to Chemotherapy-Induced Ovarian Failure

Chemotherapy-induced ovarian failure causes rapid bone loss in premenopausal women with early breast cancer. The aim of the present study was to investigate the effect of intravenous intermittent clodronate during adjuvant chemotherapy in prevention of this rapid bone loss. 45 premenopausal women with early stage breast cancer were treated with adjuvant chemotherapy. In addition, all women were randomly allocated to receive either seven cycles of intravenous clodronate infusions (1500 mg each) parallel to the chemotherapy or no further therapy. The mean bone loss in the lumbar spine at 6 months was -0.5% in the clodronate group and -1.4% in the control group (p = 0.22) and, at 12 months, -3.9% and -3.6%, respectively (p = 0.62). Type I collagen metabolite PINP levels at six months were significantly lower in the clodronate group than in the control group: 22.6 microg/l (range 15.7-55.8 microg/l) and 44.0 microg/l (range 12.5-91.9 microg/l), respectively (p = 0.0001). At 12 months, no difference between the PINP levels in clodronate and control groups were seen. In conclusion, in this small study a short-term intermittent intravenous clodronate treatment did not seem to prevent clinically significantly the bone loss related to chemotherapy-induced ovarian failure in premenopausal women with early stage breast cancer, even though a significant reduction of a biochemical marker of bone turnover (PINP) was seen during the therapy.     

Adjuvant Trastuzumab for 6 Months is Effective in Patientswith HER2-positive Stage II or III Breast Cancer

Objective: The optimal duration of adjuvant trastuzumab treatment in patients with HER2-positive breastcancer is not known. The aim of this study was to evaluate the efficacy of 6 months of adjuvant trastuzumabtreatment in patients with stage II or III HER2-positive breast cancer. Methods: The records of patients withHER2-positive stage II or III breast cancer who were admitted to the Breast Center of Taipei Medical UniversityHospital and Yuan’s General Hospital between 2000 and 2008 were reviewed. All patients received adjuvanttrastuzumab at an initial dose of 4 mg/kg followed by a maintenance dose of 2 mg/kg/week for 22 weeks incombination with chemotherapy. Results: A total of 51 patients were included with a mean age of 46.9 years.Approximately 55% of the patients had stage III disease. The mean follow-up time from initiation of treatment was45.2 months (range, 0.9 to 85 months). During follow-up, 46 patients (90.2%) did not experience tumor recurrence.The mean estimated disease free survival was 80.2 months. The estimated 1- , 2-, 5-, and 7-year survival rateswere 97.9%, 93.1%, 93.1%, and 93.1%, respectively. The most common adverse effects were gastrointestinalsymptoms (21.6%), chills (17.6%), dizziness (9.8%), and bone pain (7.8%). No cardiac or hematologic adverseevents occurred. Conclusion: Adjuvant therapy with trastuzumab for 6 months resulted in a clinical benefit inpatients with HER2-positive breast cancer.     

早期乳腺癌保乳治疗的临床研究

目的：探讨早期乳腺癌保乳术后综合治疗的效果。方法：对１０８例早期乳腺癌行保乳治疗,并与同期行改良根治术治疗的１２１例早期乳腺癌行对比研究。保乳治疗患者年龄３１～６１岁,中位年龄４４.５岁。保乳术后行全乳腺放疗和瘤床加量,处方剂量５０Ｇｙ／５周,瘤床追加６～９ＭｅＶ电子线１０～１５Ｇｙ／７～１０天。改良根治术患者年龄３４～６８岁,中位年龄４７.６岁。改良根治术后放疗的范围根据肿块大小和淋巴结转移情况决定,处方剂量５０Ｇｙ／５周。两组均采用ＣＡＦ或ＣＭＦ方案化疗,ＥＲ或ＰＲ阳性的患者给予内分泌治疗。结果：１０８例保乳治疗患者中３例复发,５例出现远处转移（２例为骨转移,１例为骨、肝、肺多发转移,２例为肺转移）。术后６个月美容效果评估优、良者为９１.７％,术后１年为９２.６％。１２１例改良根治术患者中３例复发,７例出现远处转移（３例为骨转移,３例为肺转移,１例为多发脏器转移）。两组的近期疗效差异均无统计学意义（Ｐ＞０.０５）。结论：早期乳腺癌采用保乳术及术后综合治疗的疗效不低于改良根治术,且美容效果更优。     

经导管超选择动脉灌注化疗在中晚期鼻咽癌综合治疗中的价值

  目的 探讨中晚期鼻咽癌（Ⅲ，Ⅳa期）放疗前选择性动脉插管化疗（IACT）应用价值。方法 选择60例局部晚期鼻咽癌初治患者，随机分成2组各30例，放疗前分别进行IACT和静脉化疗（IVCT），于放疗后4周对2组的疗效进行比较。结果　IACT组、IVCT组有效率及1年局控率分别为93.33 %，70.00 %和92.86 %，71.43 %，两组比较差异有统计学意义（P＜0.05）。结论　选择性动脉插管化疗联合放疗治疗中晚期鼻咽癌，短期疗效显著，局控率高，毒副作用轻。     

隐匿性乳腺癌的诊断和治疗

目的 探讨隐匿性乳腺癌的诊断、治疗及预后.方法 收集23例隐匿性乳腺癌患者的临床和随访资料,并进行分析.结果 23例患者均为女性,平均57.7岁.术前行影像学检查22例,其中行乳腺超声检查17例,8例发现可疑结节;行乳腺钼靶摄片9例,阳性3例;行乳腺MRI检查2例,1例发现异常钙化.20例行同侧乳腺癌改良根治术,16例进行化疗,4例放疗.随访期间,2例患者发生肺转移,其中1例多处转移.结论 术前排除其他部位原发癌的可能后,表现为腋窝淋巴结转移癌的患者即可诊断隐匿性乳腺癌.对隐匿性乳腺癌,乳腺必须进行治疗,可行乳腺癌改良根治术或腋窝淋巴结清扫+全乳放疗.     

泰索帝联合顺铂治疗蒽环类耐药性晚期乳腺癌28例

目的 观察泰索帝联合顺铂治疗蒽环类耐药性晚期转移性乳腺癌28例的疗效与毒副反应.方法 泰索帝75 mg/m2,静滴,d1;顺铂75 mg/m2,静滴,d2-4,同时给与水化、利尿、止吐以及抗过敏预处理等治疗,21 d为1周期.中位化疗周期数为3个(2～5个)周期.结果 28例均可评价疗效.完全缓解(CR)2例(7.1%),部分缓解(PR)13例(46.4%),稳定(SD)6例(21.4%),进展(PD)7例(25%),总有效(CR PR)15例(53.6%),中位肿瘤进展时间(TTP)5.6个月,1年生存率63.7%.主要毒副反应为骨髓抑制、恶心、呕吐.结论 泰索帝和顺铂联合治疗蒽环类耐药的晚期转移性乳腺癌疗效较好,毒副反应轻,耐受性较好,是蒽环类耐药性乳腺癌的有效治疗方案.     

紫杉醇联合顺铂治疗48例蒽环类耐药性晚期乳腺癌

目的：观察紫杉醇联合顺铂方案治疗蒽环类耐药性晚期转移性乳腺癌(MBC)的疗效与不良反应。方法：2000年3月～2002年10月。采用紫杉醇联合顺铂方案治疗蒽环类耐药性MBC48例。全组化疗共144个周期。中位周期数为3(2。5)个。结果：CR6例，PR21例，SD12例，PD9例，总有效率(CR PR)56．2％。全组中位缓解期6．5(2～12)个月，中位TTP为7．6(2～14)个月，主要剂量毒性为骨髓抑制，胃肠道反应和关节肌肉疼痛。骨髓抑制以白细胞减少为主，Ⅲ～Ⅳ度白细胞减少的发生率为18．7％。结论：紫杉醇联合顺铂方案治疗蒽环类耐药性MBC有较好的疗效且不良反应可以耐受。     

Weekly TP regimen as a postoperative adjuvant chemotherapy for completely resected breast cancer in China: final result of a phase II trial

Objectives: To investigate the safety and long-term survival with weekly paclitaxel combined with cisplatin (wTP) as a postoperative adjuvant chemotherapy regimen for breast cancer. Methods: Patients with breast cancer were treated postoperatively with paclitaxel 40 mg/m2 intravenously on days 1, 8 and 15, cisplatin 25 mg/m2 also intravenously on days 1,8 and 15, repeated every 21-28 days as a cycle. Toxicity and survival rate were evaluated after chemotherapy. Results: Between September 1993 and August 2001, 20 patients were enrolled. Median age was 52 years (range, 35–71 years). According to the TNM stage system, all patients were staged Ⅱ or Ⅲ. Median number of chemotherapy cycles was 3 (range, 1–6), and 10 patients received 4 to 6 cycles of wTP. After a median follow-up of 83 months, 2 deaths and 6 relapses were documented. The five year overall survival rate was 90%. All patients could be evaluated with regard to toxicity. No treatment related deaths were recorded. Neutropenia occurred in 75% of patients during treatment, all recovering after G-CSF injection. Other symptoms included nausea/vomiting, elevation of transaminase, urea nitrogen/creatinine and alopecia. Conclusions: wTP is safe and effective at the doses tested. However, a randomized clinical trial is needed to compare wTP with other conventional adjuvant regimens of breast cancer postoperatively.     

Continuous infusion fluorouracil in the management of advanced breast cancer: a phase II study

AIMS AND BACKGROUND: The evaluation of unconventional schedules of well-known drugs represents a promising avenue in the search for new regimens with a better therapeutic index in metastatic breast cancer. In particular, protracted continuous infusion (PCI) of 5-fluorouracil (5-FU) has yielded interesting results in gastrointestinal malignancies and in breast cancer. METHODS: From March 1996 30 consecutive patients with heavily pretreated breast cancer were treated with PCI 5-FU at a daily dose of 250 mg/m2 by means of disposable elastomeric pumps until progression or toxicity. The median age was 54 years (range, 28-71) and median performance status was 1 (range, 0-3). All patients but four were pretreated with anthracycline-containing regimens or taxanes; the median number of chemotherapy lines was 3 (range, 2-4). Metastatic sites were predominantly visceral in 60% of the patient population. RESULTS: All 30 patients were evaluable for response and toxicity. The median duration of PCI was 20 weeks (range, 2-36 weeks). Two complete responses (7%) and eight partial remissions (26%) were observed, giving an overall response rate of 33%. The median duration of response was six months (range, 4-9 months). Stabilization was observed in seven patients (23%) with a median duration of seven months (range, 3-9 months). The main toxic effects were grade I-II mucositis and hematologic toxicity, while grade 3 hand-foot syndrome was observed in eight patients (27%). CONCLUSIONS: This study confirms the efficacy and safety of 5-FU at this dosage and schedule in heavily pretreated women with advanced breast cancer. In order to improve on these results further studies are needed in a less advanced stage of the disease and together with other active drugs.     

Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer.

PURPOSE: We sought to evaluate the effects of chemotherapy-induced ovarian failure on bone loss and markers of skeletal turnover in a prospective longitudinal study of young women with breast cancer receiving adjuvant chemotherapy. PATIENTS AND METHODS: Forty-nine premenopausal women with stage I/II breast cancers receiving adjuvant chemotherapy were evaluated within 4 weeks of starting chemotherapy (baseline), and 6 and 12 months after starting chemotherapy with dual-energy absorptiometry and markers of skeletal turnover osteocalcin and bone-specific alkaline phosphatase. Chemotherapy-induced ovarian failure was defined as a negative pregnancy test, greater than 3 months of amenorrhea, and a follicle-stimulating hormone > or = 30 MIU/mL at the 12-month evaluation. RESULTS: Among the 35 women who were defined as having ovarian failure, highly significant bone loss was observed in the lumbar spine by 6 months and increased further at 12 months. The median percentage decrease of bone mineral density in the spine from 0 to 6 months and 6 to 12 months was -4.0 (range, -10.4 to +1.0; P =.0001) and -3.7 (range, -10.1 to 9.2; P =.0001), respectively. In contrast, there were no significant decreases in bone mineral density in the 14 patients who retained ovarian function. Serum osteocalcin and bone specific alkaline phosphatase, markers of skeletal turnover, increased significantly in the women who developed ovarian failure. CONCLUSION: Chemotherapy-induced ovarian failure causes rapid and highly significant bone loss in the spine. This may have implications for long-term breast cancer survivors who may be at higher risk for osteopenia, and subsequently osteoporosis. Women with breast cancer who develop chemotherapy-induced ovarian failure should have their bone density monitored and treatments to attenuate bone loss should be evaluated.     

炎性乳腺癌38例临床报告

背景与目的：炎性乳腺癌是一种特殊类型的乳腺癌,病程进展快,预后差,本研究是为了探讨炎性乳腺癌的临床特征。治疗和预后。方法：对1970年3月20日至2001年12月21日我院收治的38例炎性乳腺癌回顾性分析。结果：炎性乳腺癌的主要症状为乳房皮肤的局部或弥漫红肿,不发热,38例患者中位年龄45岁,Ⅲb期24例。Ⅳ期14例,首选局部治疗18例,首选化疗20例,中位生存期17个月,1年生存率57.7%,5年生存率14.0%,首选化疗者中位生存期明显延长,分期早者较分期晚者预后好。结论：炎性乳腺癌应采用以化疗为主的综合治疗。     

Serum selenium measurements in women with early-stage breast cancer with and without chemotherapy-induced ovarian failure

Blood selenium has been shown to decline as breast cancer progresses and fluctuate with estrogen. The objective of this study was to determine the effect of estrogen depletion resulting from chemotherapy-induced ovarian failure on serum selenium and selenoproteins in stage I/II premenopausal breast cancer patients. Serum selenium, glutathione peroxidase (GPx) activity, and selenoprotein P (SelP) were measured and a dietary questionnaire was completed at baseline (before chemotherapy) and 6, 12, and 24 months after start of chemotherapy. Twelve months after the start of adjuvant chemotherapy 33 (75%) patients developed ovarian failure (OF) and 11 (25%) retained menstrual function (non-OF). Dietary selenium intake was 30–58% above the Recommended Dietary Allowance for both groups. By six months the mean estradiol (pg/ml) was lower in the OF group than in the non-OF group (32±5 versus 140±62 pg/ml, p=0.01) and this difference was maintained at 12 and 24 months. However, there was no differences in serum selenium, GPx activity, or SelP in the OF and non-OF groups at 6, 12, and 24 months. Selenium status in premenopausal breast cancer patients, as measured by serum selenium, GPx and SelP, was within the normal range before and following adjuvant chemotherapy, and was not affected by chemotherapy-induced ovarian failure.     

Male breast cancer: A retrospective study from a regional cancer center in northern India

Over a 7-year period from 1987 to 1993, 41 male breast cancer patients were seen in the breast cancer clinic of the Institute Rotary Cancer Hospital (IRCH) at the All India Institute of Medical Sciences (AIIMS). Their mean age was 54.2 years; and duration of symptoms ranged from 1 to 84 months with a mean of 15.1 months. Breast lump was the commonest presenting symptom. Fine needle aspiration cytology (FNAC) was the commonest diagnostic procedure. The TNM stage distribution was stage I, 5; stage II, 13; stage III, 17; and stage IV, 6. Radical mastectomy (25/36) was the commonest surgical procedure. Locoregional radiotherapy was given in 15 patients. Thirty patients received systemic adjuvant therapy (chemotherapy or tamoxifen, or a combination of the two). Local or distant recurrence occurred in 8 patients (8/31, 28.3%). Actuarial overall and disease-free survival was 100% and 80.1% at 2 years and 91.7% and 66.7% at 4 years, respectively. On univariate analysis, axillary lymph node status and age were found to affect disease-free survival significantly. Advanced stage of disease at presentation is common in Indian patients and will continue to influence treatment policies. Neoadjuvant chemotherapy needs to be evaluated for locally advanced tumors to improve outcome. Multicentric studies are necessary to define the relative roles of tamoxifen and chemotherapy for adjuvant treatment. © 1996 Wiley-Liss, Inc.     

Dose-dense sequential chemotherapy with epirubicin and paclitaxel in advanced breast cancer

The purpose of this study was to evaluate the activity and toxicity profile of dose-dense sequential chemotherapy with epirubicin (EPI) and paclitaxel in advanced breast cancer (ABC). From January to September 1997, 41 patients with recurrent or metastatic (stage IV) breast cancer were enrolled in the study. Their median age was 57 (range, 33-77) years and median performance status 0 (range, 0-2). Twenty patients had received adjuvant chemotherapy. The chemotherapeutic regimen consisted of 4 cycles of EPI 110 mg/m2 every 2 weeks followed by 4 cycles of paclitaxel, 225 mg/m2 over 3 hours every 2 weeks. G-CSF was administered prophylactically on days 2-10 of each cycle. 34 (83.0%) patients completed all 8 cycles of chemotherapy. A total of 304 cycles were administered, 259 (85.0%) of them at full dose. Thirty (10.0%) cycles were delivered with a delay. The relative median dose intensities of EPI and paclitaxel were 0.95. Most common grade 3-4 side effects were anemia (15.0%) neutropenia (12.0%), thrombocytopenia (5.0%), nausea/vomiting (10.0%), febrile neutropenia (7.5%), and alopecia (90.0%). Overall, 8 (19.5%) patients achieved a complete and 15 (36.5%) a partial response. Median duration of response was 8.4 (range, 3.1-15.5+) months. After a median follow-up of 18.5 months, median time to progression was 8.7 (range, 0.5-21+) months; median survival has not been reached yet. Dose-dense sequential chemotherapy with EPI and paclitaxel shows promising activity as first-line treatment in ABC. Randomized studies comparing this type of chemotherapy with the classical administration of the two drugs together every 3 weeks are ongoing.     

Patient and tumor characteristics associated with breast cancer recurrence after complete pathological response to neoadjuvant chemotherapy

Breast cancer patients whose tumors achieve a pathological complete response (pCR) with neoadjuvant chemotherapy have a prognosis which is better than that predicted for the stage of their disease. However, within this subgroup of patients, recurrences have been observed. We sought to examine factors associated with recurrence in a population of breast cancer patients who achieved a pCR with neoadjuvant chemotherapy. A retrospective chart review was conducted of all patients with unilateral breast cancer treated with neoadjuvant chemotherapy from January 1, 2000 to December 31, 2010 at one comprehensive cancer center. A pCR was defined as no residual invasive cancer in the breast in the surgical specimen following neoadjuvant therapy. Recurrence was defined as visceral or bony reappearance of cancer after completion of all therapy. Of 818 patients who completed neoadjuvant chemotherapy, 144 (17.6 %) had pCR; six with bilateral breast cancer were excluded from further analysis. The mean time to follow-up was 47.2 months. Among the 138 patients with unilateral breast cancer, there were 14 recurrences (10.1 %). Using a binary multiple logistic regression model, examining types of chemotherapy and surgery, race, lymph node assessment, and lymph node status, breast cancer side, triple-negative status, and radiation receipt, only African-American patients (OR: 5.827, 95 % CI: 1.280–26.525; p = 0.023) were more likely to develop distant recurrence. The mean time to recurrence was 31.9 months. In our study, race was the only independent predictor of recurrence after achieving pCR with neoadjuvant chemotherapy. The reasons for this observation require further study.     

Long-Term Oncologic Outcome of Breast Cancer in Southern Iran: A Retrospective Cohort Study

Introduction: Breast cancer remains the most frequent and lethal cancer among women worldwide. This study aimed to investigate the characteristics, prognostic factors and outcome of breast cancer patient treated and followed-up in Shiraz, southern Iran from 2000 to 2005. Methods: In this retrospective study, 1,024 patients with breast cancer who were treated in Namazi hospital of Shiraz University of Medical Sciences between 2000 and 2005 were included. Survival analysis was performed to determine potential factors influencing disease free-and overall survival in these patients. Results: Median age of the patients at diagnosis was 47 (range 19-83) years. Median follow-up for surviving patients was 68 months. The majority of patients presented at stage II (42%) and stage III (41%). Additionally, most (61%) patients had positive axillary node. The 5-, 10- and 15-year overall survival rates were 83.8%, 61.5% and 56.6% respectively. On multivariate analysis for overall survival, histologic type, Tumor stage, node stage, disease stage, M stage, hormone receptor status, adjuvant radiotherapy, and chemotherapy regimen remained independent prognostic factor for overall survival. Conclusion: in this study, the poor long-term oncologic outcome of the patients with breast cancer may be due to the higher rate of locally advanced disease; as well as the lack of modern systemic therapies in the study period.