The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery

Richard A. Sorace, Caroline S. Bagley, Allen S. Lichter, David N. Danforth, Margaret W. Wesley, Robert C. Young, Marc E Lippman

Research output: Contribution to journalArticle

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Abstract

Forty-three patients with locally advanced breast cancer, 15 with stage IIIA and 28 with stage IIIB, received primary induction chemotherapy, including hormonal synchronization in 38 patients, to a maximum objective clinical response before proceeding to local therapy. Patients achieving a pathological complete response received radiation therapy, while patients with residual disease, partial response (PR), or no change (NC) status received debulking surgery prior to radiation therapy; in all patients, 6 additional months of chemotherapy were administered. Chemotherapy consisted of cyclophosphamide 500 mg/m2 and doxorubicin 30 mg/m2 intravenously day 1; tamoxifen 40 mg/m2 orally days 2-6; premarin 0.625 mg orally every 12 hours 3 times beginning on day 7; methotrexate (mtx) 300 mg/m2 intravenously followed in 1 hour by 5-fluorouracil 500 mg/m2 intravenously day 8, and leucovorin 10 mg/m2 orally every 6 hours 6 times beginning 24 hours after mtx. Forty-two patients are evaluable with respect to response, time to progression, and survival. Objective response rate to chemotherapy was 90% with 50% CR, 40% PR, and 10% NC. Median number of cycles of chemotherapy to achieve a CR, PR, or NC was 5, 4, and 4 respectively. Eighteen patients with a CR to chemotherapy were assessed by multiple biopsies (16 patients) or mastectomy (2 patients). Fourteen patients (70%) were proven to be pathological complete responders. Thirty patients have completed combined therapy thus far and all have been rendered disease free. Seven stage IIIB patients have relapsed, 6 of them having inflammatory histological findings. No stage IIIA patients have relapsed. Median survival and time to progression have not been reached for either stage.

Original languageEnglish
Pages (from-to)775-785
Number of pages11
JournalWorld Journal of Surgery
Volume9
Issue number5
DOIs
StatePublished - Oct 1 1985
Externally publishedYes

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Induction Chemotherapy
Radiotherapy
Breast Neoplasms
Drug Therapy
Methotrexate
Conjugated (USP) Estrogens
Survival
Leucovorin
Mastectomy
Tamoxifen
Fluorouracil
Doxorubicin
Cyclophosphamide
Reaction Time

ASJC Scopus subject areas

  • Surgery

Cite this

The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery. / Sorace, Richard A.; Bagley, Caroline S.; Lichter, Allen S.; Danforth, David N.; Wesley, Margaret W.; Young, Robert C.; Lippman, Marc E.

In: World Journal of Surgery, Vol. 9, No. 5, 01.10.1985, p. 775-785.

Research output: Contribution to journalArticle

Sorace, Richard A. ; Bagley, Caroline S. ; Lichter, Allen S. ; Danforth, David N. ; Wesley, Margaret W. ; Young, Robert C. ; Lippman, Marc E. / The management of nonmetastatic locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery. In: World Journal of Surgery. 1985 ; Vol. 9, No. 5. pp. 775-785.
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abstract = "Forty-three patients with locally advanced breast cancer, 15 with stage IIIA and 28 with stage IIIB, received primary induction chemotherapy, including hormonal synchronization in 38 patients, to a maximum objective clinical response before proceeding to local therapy. Patients achieving a pathological complete response received radiation therapy, while patients with residual disease, partial response (PR), or no change (NC) status received debulking surgery prior to radiation therapy; in all patients, 6 additional months of chemotherapy were administered. Chemotherapy consisted of cyclophosphamide 500 mg/m2 and doxorubicin 30 mg/m2 intravenously day 1; tamoxifen 40 mg/m2 orally days 2-6; premarin 0.625 mg orally every 12 hours 3 times beginning on day 7; methotrexate (mtx) 300 mg/m2 intravenously followed in 1 hour by 5-fluorouracil 500 mg/m2 intravenously day 8, and leucovorin 10 mg/m2 orally every 6 hours 6 times beginning 24 hours after mtx. Forty-two patients are evaluable with respect to response, time to progression, and survival. Objective response rate to chemotherapy was 90{\%} with 50{\%} CR, 40{\%} PR, and 10{\%} NC. Median number of cycles of chemotherapy to achieve a CR, PR, or NC was 5, 4, and 4 respectively. Eighteen patients with a CR to chemotherapy were assessed by multiple biopsies (16 patients) or mastectomy (2 patients). Fourteen patients (70{\%}) were proven to be pathological complete responders. Thirty patients have completed combined therapy thus far and all have been rendered disease free. Seven stage IIIB patients have relapsed, 6 of them having inflammatory histological findings. No stage IIIA patients have relapsed. Median survival and time to progression have not been reached for either stage.",
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