PARIS, France--Radiation therapy is a reasonable alternative to
mastectomy in women with stage IIIA and IIIB breast cancer who
respond to aggressive chemohormonal therapy, a prospective trial
conducted at the University of Michigan has found.
The 91 women enrolled in this study received nine cycles of a
hormonal synchronization regimen consisting of cyclophosphamide,
doxorubicin, methotrexate, and fluorouracil with conjugated estrogens
and tamoxifen (Nolvadex).
The nearly 30% of patients evaluated who showed a complete pathologic
response to induction therapy went on to receive radiation therapy
to the breast (median dose, 5,000 cGy), tumor bed (6,400 cGy),
supraclavicular fossa (4,500 cGy), and axilla (4,500 cGy), with
concomitant chemotherapy followed by eight additional rounds of
maintenance chemotherapy, Lori Pierce, MD, said at the American
Radium Society meeting.
Women who exhibited residual tumor on surgical biopsy underwent
modified radical mastectomy followed by irradiation to the chest
wall (median dose, 5,000 cGy), scar (6,000 cGy), and supraclavicular
fossa (4,500 cGy), and nine cycles of maintenance chemotherapy.
Both groups of women were comparable in terms of primary tumor
size, nodal status, stage at presentation, age, and menopausal
status, Dr. Pierce said.
The 5-year local-regional control rate of 82% in women treated
with breast-conserving therapy was similar to the 5-year control
rate of 75% among the surgically treated patients, said Dr. Pierce,
of the Department of Radiation Oncol-ogy, University of Michigan
Medical Center, Ann Arbor.
"When we did a multivariate analysis we found no factors
that would independently predict for local failure, but we did
find that survival was significantly worse in patients with stage
IIIB disease than in those with IIIA disease," she said.