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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