Breast Preservation Seems Feasible in Chemohormonal Responders

PARIS, France--Radiation therapy is a reasonable alternative tomastectomy in women with stage IIIA and IIIB breast cancer whorespond to aggressive chemohormonal therapy, a prospective trialconducted at the University of Michigan has found.

The 91 women enrolled in this study received nine cycles of ahormonal synchronization regimen consisting of cyclophosphamide,doxorubicin, methotrexate, and fluorouracil with conjugated estrogensand tamoxifen (Nolvadex).

The nearly 30% of patients evaluated who showed a complete pathologicresponse to induction therapy went on to receive radiation therapyto the breast (median dose, 5,000 cGy), tumor bed (6,400 cGy),supraclavicular fossa (4,500 cGy), and axilla (4,500 cGy), withconcomitant chemotherapy followed by eight additional rounds ofmaintenance chemotherapy, Lori Pierce, MD, said at the AmericanRadium Society meeting.

Women who exhibited residual tumor on surgical biopsy underwentmodified radical mastectomy followed by irradiation to the chestwall (median dose, 5,000 cGy), scar (6,000 cGy), and supraclavicularfossa (4,500 cGy), and nine cycles of maintenance chemotherapy.

Both groups of women were comparable in terms of primary tumorsize, nodal status, stage at presentation, age, and menopausalstatus, Dr. Pierce said.

The 5-year local-regional control rate of 82% in women treatedwith breast-conserving therapy was similar to the 5-year controlrate of 75% among the surgically treated patients, said Dr. Pierce,of the Department of Radiation Oncol-ogy, University of MichiganMedical Center, Ann Arbor.

"When we did a multivariate analysis we found no factorsthat would independently predict for local failure, but we didfind that survival was significantly worse in patients with stageIIIB disease than in those with IIIA disease," she said.

While maintaining that candidates for breast preservation canbe selected on the basis of their response to chemohormonal therapy,Dr. Pierce cautioned that further study is necessary before thisapproach is tried with other adjuvant treatment regimens.