Primary Chemotherapy Allows Breast-Conserving Surgery in French Study

SAN ANTONIO--Primary chemotherapy successfully converted 29 of47 mastectomy candidates to breast conservation in a French studyreported at the San Antonio Breast Cancer Symposium.

All the patients had infiltrating carcinoma of the breast. Eachwoman had a single tumor between 4 cm and 7 cm. No patient hada lymph node larger than 2.5 cm in diameter, and none had inflammatorysigns, reported Beatrice Weber, MD, an oncologist at Centre AlexisVautrin, Vandoeuvre-les-Nancy, France.

The mean age of the women was 42, and 36 were premenopausal. Histologywas ductal carcinoma in 38 patients.

In an effort to avoid mastectomy, the women underwent three orfour cycles of combination chemotherapy after initial biopsy:doxorubicin or epirubicin on day 1, cyclophosphamide over 4 days,and fluorouracil over 4 days.

Patients who had tumor responses that permitted lumpectomy hadan additional two or three cycles of chemotherapy prior to surgery.Chemotherapy continued after surgery, for a total of nine cycles,followed by radiation therapy.

As assessed by reduction in tumor size, 30 patients had significantresponses to the chemotherapy. With respect to nodal status, 31had significant responses, Dr. Weber said in her poster presentation.

At a median follow-up of 48 months, 27 of 29 patients treatedconservatively remained alive, including all 14 who had positivelymph nodes, compared with 14 of 18 mastectomy patients stillalive.

Dr. Weber suggested that results could improve with selectionof patients on the basis of their probability of response to chemotherapy,as determined by histologic grade, S-phase fraction, and ER status,and with increased dose intensity.