Abstract
One hundred and seven patients with locally advanced breast cancer were prospectively referred for multimodality treatment on protocol using chemohormonal therapy to maximal response followed by local treatment and maintenance therapy. Forty-eight patients (45%) were diagnosed with Stage IIIA disease, 46 (43%) with Stage IIIB inflammatory cancer, and 13 (12%) with Stage IIIB non-inflammatory disease. Induction therapy consisted of cyclophosphamide, doxorubicin, methotrexate, and 5-fluorouracil with hormonal synchronization using tamoxifen and conjugated estrogens. Local treatment was determined by response to chemotherapy. Patients with a clinical partial response underwent mastectomy followed by local-regional radiotherapy while patients with a clinical complete response were biopsied for pathologic correlation. Those with residual disease received mastectomy followed by radiotherapy while those with a pathologic complete response received radiation only to the intact breast and regional nodes. With a median follow-up of 64 months, patients with IIIA disease had a significantly lower local-regional failure rate compared to IIIB inflammatory patients, with the 5-year actuarial local-regional failure rate as only site of first failure 3% for IIIA disease versus 21% for IIIB inflammatory cancer (p = .02), and local-regional failure as any component of first failure 12% versus 36% (p = .01), respectively. When local-regional failure was analyzed by repeat biopsy, 5 31 (16%) patients with a pathologic complete response treated with radiation only developed a local-regional failure versus 2 53 (4%) with residual disease treated with mastectomy and postoperative radiotherapy. The 5-year actuarial local-regional failure rate as first site of failure was 23% for radiation only versus 5% for mastectomy and post-operative radiotherapy (p = .07). The response to chemotherapy did not reliably predict local-regional control. Both relapse-free survival and overall survival were significantly better for IIIA versus IIIB patients; stratification by repeat biopsy did not, however, significantly affect either relapse-free or overall survival.
| Original language | English |
|---|---|
| Pages (from-to) | 949-960 |
| Number of pages | 12 |
| Journal | International journal of radiation oncology, biology, physics |
| Volume | 23 |
| Issue number | 5 |
| DOIs | |
| State | Published - Jan 1 1992 |
| Externally published | Yes |
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Keywords
- Breast cancer
- Local-regional control
- Locally advanced
- Radiation Therapy
ASJC Scopus subject areas
- Oncology
- Radiology Nuclear Medicine and imaging
- Radiation
Cite this
The effect of systemic therapy on local-regional control in locally advanced breast cancer. / Pierce, Lori J.; Lippman, Marc E; Ben-Baruch, Noa; Swain, Sandra; O'shaughnessy, Joyce; Bader, Judith L.; Danforth, David; Venzon, David; Cowan, Kenneth H.
In: International journal of radiation oncology, biology, physics, Vol. 23, No. 5, 01.01.1992, p. 949-960.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The effect of systemic therapy on local-regional control in locally advanced breast cancer
AU - Pierce, Lori J.
AU - Lippman, Marc E
AU - Ben-Baruch, Noa
AU - Swain, Sandra
AU - O'shaughnessy, Joyce
AU - Bader, Judith L.
AU - Danforth, David
AU - Venzon, David
AU - Cowan, Kenneth H.
PY - 1992/1/1
Y1 - 1992/1/1
N2 - One hundred and seven patients with locally advanced breast cancer were prospectively referred for multimodality treatment on protocol using chemohormonal therapy to maximal response followed by local treatment and maintenance therapy. Forty-eight patients (45%) were diagnosed with Stage IIIA disease, 46 (43%) with Stage IIIB inflammatory cancer, and 13 (12%) with Stage IIIB non-inflammatory disease. Induction therapy consisted of cyclophosphamide, doxorubicin, methotrexate, and 5-fluorouracil with hormonal synchronization using tamoxifen and conjugated estrogens. Local treatment was determined by response to chemotherapy. Patients with a clinical partial response underwent mastectomy followed by local-regional radiotherapy while patients with a clinical complete response were biopsied for pathologic correlation. Those with residual disease received mastectomy followed by radiotherapy while those with a pathologic complete response received radiation only to the intact breast and regional nodes. With a median follow-up of 64 months, patients with IIIA disease had a significantly lower local-regional failure rate compared to IIIB inflammatory patients, with the 5-year actuarial local-regional failure rate as only site of first failure 3% for IIIA disease versus 21% for IIIB inflammatory cancer (p = .02), and local-regional failure as any component of first failure 12% versus 36% (p = .01), respectively. When local-regional failure was analyzed by repeat biopsy, 5 31 (16%) patients with a pathologic complete response treated with radiation only developed a local-regional failure versus 2 53 (4%) with residual disease treated with mastectomy and postoperative radiotherapy. The 5-year actuarial local-regional failure rate as first site of failure was 23% for radiation only versus 5% for mastectomy and post-operative radiotherapy (p = .07). The response to chemotherapy did not reliably predict local-regional control. Both relapse-free survival and overall survival were significantly better for IIIA versus IIIB patients; stratification by repeat biopsy did not, however, significantly affect either relapse-free or overall survival.
AB - One hundred and seven patients with locally advanced breast cancer were prospectively referred for multimodality treatment on protocol using chemohormonal therapy to maximal response followed by local treatment and maintenance therapy. Forty-eight patients (45%) were diagnosed with Stage IIIA disease, 46 (43%) with Stage IIIB inflammatory cancer, and 13 (12%) with Stage IIIB non-inflammatory disease. Induction therapy consisted of cyclophosphamide, doxorubicin, methotrexate, and 5-fluorouracil with hormonal synchronization using tamoxifen and conjugated estrogens. Local treatment was determined by response to chemotherapy. Patients with a clinical partial response underwent mastectomy followed by local-regional radiotherapy while patients with a clinical complete response were biopsied for pathologic correlation. Those with residual disease received mastectomy followed by radiotherapy while those with a pathologic complete response received radiation only to the intact breast and regional nodes. With a median follow-up of 64 months, patients with IIIA disease had a significantly lower local-regional failure rate compared to IIIB inflammatory patients, with the 5-year actuarial local-regional failure rate as only site of first failure 3% for IIIA disease versus 21% for IIIB inflammatory cancer (p = .02), and local-regional failure as any component of first failure 12% versus 36% (p = .01), respectively. When local-regional failure was analyzed by repeat biopsy, 5 31 (16%) patients with a pathologic complete response treated with radiation only developed a local-regional failure versus 2 53 (4%) with residual disease treated with mastectomy and postoperative radiotherapy. The 5-year actuarial local-regional failure rate as first site of failure was 23% for radiation only versus 5% for mastectomy and post-operative radiotherapy (p = .07). The response to chemotherapy did not reliably predict local-regional control. Both relapse-free survival and overall survival were significantly better for IIIA versus IIIB patients; stratification by repeat biopsy did not, however, significantly affect either relapse-free or overall survival.
KW - Breast cancer
KW - Local-regional control
KW - Locally advanced
KW - Radiation Therapy
UR - http://www.scopus.com/inward/record.url?scp=0026728754&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0026728754&partnerID=8YFLogxK
U2 - 10.1016/0360-3016(92)90899-S
DO - 10.1016/0360-3016(92)90899-S
M3 - Article
C2 - 1639655
AN - SCOPUS:0026728754
VL - 23
SP - 949
EP - 960
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
SN - 0360-3016
IS - 5
ER -