Cance presented the follow-up results April 25 at the 122nd Annual Meeting of the American Surgical Association in Hot Springs, Va. Cance, along with UNC colleagues Drs. Mark Graham II and Julian Rosenman, wrote the original protocol for the study, which ended in 1998. Drs. Lisa A. Carey, Benjamin F. Calvo and David W. Ollila also joined the study.
"This is among the longest follow ups in neoadjuvant therapy nationally," Cance said, adding that the treatment regimen used was aggressive, dose-intense and time-intense.
It was also one of the briefest treatments used, he added. "Our neoadjuvant treatment protocol emphasized timely completion of all modalities of therapy - chemotherapy, surgery, post-operative chemotherapy and radiation therapy - within 32 weeks, with minimal interval between modalities," he said.
The 62 women studied all had locally advanced primary breast tumors greater than five centimeters, with skin or chest wall involvement, or with extensive involvement of the axillary (armpit) lymph nodes. The median age was 44 years, and roughly two-thirds were white and one-third were black. At diagnosis, 51 (82 percent) of the patients had tumors at clinical stage III, with 34 at stage IIIA and 17 at stage IIIB. Three patients were considered at stage IV. In addition, 13 patients (21 percent) had inflammatory breast cancer, which traditionally has been thought to have a poor prognosis.
Overall, 84 percent of patients showed a significant clinical response to chemotherapy. No patient's tumor worsened while taking dose-intense neoadjuvant treatment with doxorubicin. A total of 28 patients (45 percent) had sufficient downstaging of their tumor to permit an attempt at breast conserving therapy, or lumpectomy (segmental mastectomy). Of these, 22 (79 percent) had successful breast preservation, while six required complete mastectomy due to laboratory determination of cancer in the margins of surger
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Contact: Leslie lang
LLANG@MED.UNC.EDU
919-843-9687
University of North Carolina School of Medicine
26-Apr-2002