PURPOSE: This was a retrospective observational study to elicit the outcome of the therapeutic strategy of concurrent neoadjuvant chemoradiotherapy protocol for locally advanced breast cancer. METHODS AND MATERIALS: A large series of 1,117 consecutive cases of locally advanced breast cancer treated at the Cancer Institute (WIA), in Chennai, South India, between 1990 and 1999 and followed through 2004 formed the basis for this study. Disease-free survival was the main outcome, and nodal and tumor downstaging were the intermediate outcome measures studied. RESULTS: Primary tumor downstaging was observed in 45% and nodal downstaging in 57.5%. The disease-free survival rate of nodal downstaged patients at 5, 10, and 15 years was 75%, 65%, and 58%, respectively. The corresponding rates for pre- and postoperative node-negative patients were 70%, 60%, and 59%. The best survival was seen among those who were tumor and node negative postoperatively. Nodal downstaging halved the risk of disease recurrence and death compared with node positivity, irrespective of tumor sterility. CONCLUSIONS: A randomized trial using cyclophosphamide, methotrexate, and 5-fluorouracil vs. an anthracycline-based regimen in the setting of concurrent chemoradiotherapy appears indicated. Additional preoperative chemotherapy to maximize nodal and tumor downstaging should be investigated. A change in postoperative chemotherapy according to nodal status could also be explored.
PURPOSE: This was a retrospective observational study to elicit the outcome of the therapeutic strategy of concurrent neoadjuvant chemoradiotherapy protocol for locally advanced breast cancer. METHODS AND MATERIALS: A large series of 1,117 consecutive cases of locally advanced breast cancer treated at the Cancer Institute (WIA), in Chennai, South India, between 1990 and 1999 and followed through 2004 formed the basis for this study. Disease-free survival was the main outcome, and nodal and tumor downstaging were the intermediate outcome measures studied. RESULTS:Primary tumor downstaging was observed in 45% and nodal downstaging in 57.5%. The disease-free survival rate of nodal downstaged patients at 5, 10, and 15 years was 75%, 65%, and 58%, respectively. The corresponding rates for pre- and postoperative node-negative patients were 70%, 60%, and 59%. The best survival was seen among those who were tumor and node negative postoperatively. Nodal downstaging halved the risk of disease recurrence and death compared with node positivity, irrespective of tumor sterility. CONCLUSIONS: A randomized trial using cyclophosphamide, methotrexate, and 5-fluorouracil vs. an anthracycline-based regimen in the setting of concurrent chemoradiotherapy appears indicated. Additional preoperative chemotherapy to maximize nodal and tumor downstaging should be investigated. A change in postoperative chemotherapy according to nodal status could also be explored.
Authors: Sylvia Adams; A Bapsi Chakravarthy; Martin Donach; Darcy Spicer; Stella Lymberis; Baljit Singh; Joshua A Bauer; Tsivia Hochman; Judith D Goldberg; Franco Muggia; Robert J Schneider; Jennifer A Pietenpol; Silvia C Formenti Journal: Breast Cancer Res Treat Date: 2010-09-29 Impact factor: 4.872
Authors: C Matuschek; E Bölke; S L Roth; K Orth; I Lang; H Bojar; J W Janni; W Audretsch; C Nestle-Kraemling; G Lammering; V Speer; S Gripp; P A Gerber; B A Buhren; R Sauer; M Peiper; M Schauer; M Dommach; K Struse-Soll; W Budach Journal: Strahlenther Onkol Date: 2012-08-11 Impact factor: 3.621
Authors: Wilfried Budach; Christiane Matuschek; Edwin Bölke; Jürgen Dunst; Petra Feyer; Rainer Fietkau; Wulf Haase; Wolfgang Harms; Marc D Piroth; Marie-Luise Sautter-Bihl; Felix Sedlmayer; Rainer Souchon; Frederik Wenz; Frederick Wenz; Rolf Sauer Journal: Strahlenther Onkol Date: 2015-05-12 Impact factor: 3.621
Authors: Bharath Rangarajan; Tanuja Shet; Tabassum Wadasadawala; Nita S Nair; R Madhu Sairam; Sachin S Hingmire; Jyoti Bajpai Journal: South Asian J Cancer Date: 2016 Jul-Sep