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Intensive Therapy Possible Alternative to Surgery for Breast Cancer: Presented at IBCC

By Alison Palkhivala

BANFF, AB -- August 6, 2003 -- Breast cancer patients who respond well to intensive chemotherapy, radiotherapy, and possibly hormonal therapy may not require surgery, according to findings of a pilot study presented August 2^nd during a poster session here at the Second Annual Future of Breast Cancer: An International Breast Cancer Congress.

Roger Poisson, MD, St. Luc Hospital, Montreal, Quebec, Canada, and colleagues performed their study to see whether they could use chemotherapy, radiation, and hormonal therapy to treat patients with T2 and T3 breast tumors, and obtain similar results as those obtained with surgery.

Between 1991 and 1997, the investigators treated patients with doxorubicin 60 mg/m² and cyclophosphamide 600 mg/m² (AC) for 5 cycles at 3-week intervals. Starting in 1997, the researchers switched to a protocol consisting of 5-fluorouracil (5-FU), cyclophosphamide and 100 mg/m² of epirubicin (FEC) for 6 cycles, 3 weeks apart. All patients had a positive fine-needle aspiration or tru-cut biopsy, with estrogen- and progesterone-receptor determination.

Patients who achieved a complete clinical response began 50-Gy of radiotherapy 3 weeks later administered to the breast and lymph-node drainage area for 5 weeks, followed by a boost of 15 Gy in the involved quadrant. Patients who were estrogen-receptor positive went on to receive 5 years of tamoxifen therapy. After 1 to 2 months, patients underwent several core needle biopsies under stereotaxis to determine the presence of pathological complete response.

Only patients who did not attain pathological complete response underwent surgery.

Overall, the investigators included 114 out of 436 patients with proven pathologic complete response in this pilot study, because the others required some kind of surgery. Among these 114 patients, after a median follow-up of 7 years, locoregional recurrence is 16% and overall survival is 70%. Distant metastases remain a problem, however.

The authors speculate that newer approaches, such as dose-dense chemotherapy using a combination of doxorubicin, cyclophosphamide, and taxotere may result in even better outcomes. They emphasize that these patients must be followed carefully with multiple mammographies, ultrasounds, magnetic-resonance imaging scans, and biopsies.


[Study title: Is it Possible to Treat Some T2-T3 Breast Cancers Without any Surgery? (a Pilot Study). Poster 7]

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