Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy

S. A. McIntosh, Keith Nicholas Ogston, S. Payne, Iain D Miller, T. K. Sarkar, A. W. Hutcheon, Steven Darryll Heys

Research output: Contribution to journalArticle

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Abstract

Background: Primary chemotherapy is being given in the treatment of large and locally advanced breast cancers, but a major concern is local relapse after therapy. This paper has examined patients treated with primary chemotherapy and surgery (either breast-conserving surgery or mastectomy) and has examined the role of factors which may indicate those patients who are subsequently more likely to experience local recurrence of,disease.

Methods: A consecutive series of 173 women, with data available for 166 of these, presenting with large and locally advanced breast cancer (T2 >4 cm, T3, T4, or N2) were treated with primary chemotherapy comprising cyclophosphamide, vincristine, doxorubicin, and prednisolone and then surgery (either conservation or mastectomy with axillary surgery) followed by radiotherapy were examined.

Results: The clinical response rate of these patients was 75% (21% complete and 54% partial), with a complete pathological response rate of 15%. A total of 10 patients (6%) experienced local disease relapse, and the median time to relapse was 14 months (ranging from 3 to 40). The median survival in this group was 27 months (ranging from 13 to 78). In patients having breast conservation surgery, local recurrence occurred in 2%, and in those undergoing mastectomy 7% experience local relapse of disease. Factors predicting patients most likely to experience local recurrence were poor clinical response and residual axillary nodal disease after chemotherapy.

Conclusions: Excellent local control of disease can be achieved in patients with large and locally advanced breast cancers using a combination of primary chemotherapy, surgery and radiotherapy. However, the presence of residual tumor in the axillary lymph nodes after chemotherapy is a predictor of local recurrence and patients with a better clinical response were also less likely to experience local disease recurrence. The size and degree of pathological response did not predict patients most likely to experience recurrence of disease. (C) 2003 Excerpta Medica, Inc. All rights reserved.

Original languageEnglish
Pages (from-to)525-531
Number of pages6
JournalAmerican Journal of Surgery
Volume185
Issue number6
DOIs
Publication statusPublished - 2003

Keywords

  • breast cancer
  • recurrence
  • primary chemotherapy
  • LYMPH-NODE STATUS
  • NEOADJUVANT CHEMOTHERAPY
  • RANDOMIZED TRIAL
  • PREOPERATIVE CHEMOTHERAPY
  • RADIATION-THERAPY
  • AVOID MASTECTOMY
  • TUMOR RECURRENCE
  • CARCINOMA
  • MANAGEMENT
  • SURVIVAL

Cite this

McIntosh, S. A., Ogston, K. N., Payne, S., Miller, I. D., Sarkar, T. K., Hutcheon, A. W., & Heys, S. D. (2003). Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy. American Journal of Surgery, 185(6), 525-531. https://doi.org/10.1016/S0002-9610(03)00078-3

Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy. / McIntosh, S. A.; Ogston, Keith Nicholas; Payne, S.; Miller, Iain D; Sarkar, T. K.; Hutcheon, A. W.; Heys, Steven Darryll.

In: American Journal of Surgery, Vol. 185, No. 6, 2003, p. 525-531.

Research output: Contribution to journalArticle

McIntosh, SA, Ogston, KN, Payne, S, Miller, ID, Sarkar, TK, Hutcheon, AW & Heys, SD 2003, 'Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy', American Journal of Surgery, vol. 185, no. 6, pp. 525-531. https://doi.org/10.1016/S0002-9610(03)00078-3
McIntosh, S. A. ; Ogston, Keith Nicholas ; Payne, S. ; Miller, Iain D ; Sarkar, T. K. ; Hutcheon, A. W. ; Heys, Steven Darryll. / Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy. In: American Journal of Surgery. 2003 ; Vol. 185, No. 6. pp. 525-531.
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abstract = "Background: Primary chemotherapy is being given in the treatment of large and locally advanced breast cancers, but a major concern is local relapse after therapy. This paper has examined patients treated with primary chemotherapy and surgery (either breast-conserving surgery or mastectomy) and has examined the role of factors which may indicate those patients who are subsequently more likely to experience local recurrence of,disease.Methods: A consecutive series of 173 women, with data available for 166 of these, presenting with large and locally advanced breast cancer (T2 >4 cm, T3, T4, or N2) were treated with primary chemotherapy comprising cyclophosphamide, vincristine, doxorubicin, and prednisolone and then surgery (either conservation or mastectomy with axillary surgery) followed by radiotherapy were examined.Results: The clinical response rate of these patients was 75{\%} (21{\%} complete and 54{\%} partial), with a complete pathological response rate of 15{\%}. A total of 10 patients (6{\%}) experienced local disease relapse, and the median time to relapse was 14 months (ranging from 3 to 40). The median survival in this group was 27 months (ranging from 13 to 78). In patients having breast conservation surgery, local recurrence occurred in 2{\%}, and in those undergoing mastectomy 7{\%} experience local relapse of disease. Factors predicting patients most likely to experience local recurrence were poor clinical response and residual axillary nodal disease after chemotherapy.Conclusions: Excellent local control of disease can be achieved in patients with large and locally advanced breast cancers using a combination of primary chemotherapy, surgery and radiotherapy. However, the presence of residual tumor in the axillary lymph nodes after chemotherapy is a predictor of local recurrence and patients with a better clinical response were also less likely to experience local disease recurrence. The size and degree of pathological response did not predict patients most likely to experience recurrence of disease. (C) 2003 Excerpta Medica, Inc. All rights reserved.",
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T1 - Local recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy

AU - McIntosh, S. A.

AU - Ogston, Keith Nicholas

AU - Payne, S.

AU - Miller, Iain D

AU - Sarkar, T. K.

AU - Hutcheon, A. W.

AU - Heys, Steven Darryll

PY - 2003

Y1 - 2003

N2 - Background: Primary chemotherapy is being given in the treatment of large and locally advanced breast cancers, but a major concern is local relapse after therapy. This paper has examined patients treated with primary chemotherapy and surgery (either breast-conserving surgery or mastectomy) and has examined the role of factors which may indicate those patients who are subsequently more likely to experience local recurrence of,disease.Methods: A consecutive series of 173 women, with data available for 166 of these, presenting with large and locally advanced breast cancer (T2 >4 cm, T3, T4, or N2) were treated with primary chemotherapy comprising cyclophosphamide, vincristine, doxorubicin, and prednisolone and then surgery (either conservation or mastectomy with axillary surgery) followed by radiotherapy were examined.Results: The clinical response rate of these patients was 75% (21% complete and 54% partial), with a complete pathological response rate of 15%. A total of 10 patients (6%) experienced local disease relapse, and the median time to relapse was 14 months (ranging from 3 to 40). The median survival in this group was 27 months (ranging from 13 to 78). In patients having breast conservation surgery, local recurrence occurred in 2%, and in those undergoing mastectomy 7% experience local relapse of disease. Factors predicting patients most likely to experience local recurrence were poor clinical response and residual axillary nodal disease after chemotherapy.Conclusions: Excellent local control of disease can be achieved in patients with large and locally advanced breast cancers using a combination of primary chemotherapy, surgery and radiotherapy. However, the presence of residual tumor in the axillary lymph nodes after chemotherapy is a predictor of local recurrence and patients with a better clinical response were also less likely to experience local disease recurrence. The size and degree of pathological response did not predict patients most likely to experience recurrence of disease. (C) 2003 Excerpta Medica, Inc. All rights reserved.

AB - Background: Primary chemotherapy is being given in the treatment of large and locally advanced breast cancers, but a major concern is local relapse after therapy. This paper has examined patients treated with primary chemotherapy and surgery (either breast-conserving surgery or mastectomy) and has examined the role of factors which may indicate those patients who are subsequently more likely to experience local recurrence of,disease.Methods: A consecutive series of 173 women, with data available for 166 of these, presenting with large and locally advanced breast cancer (T2 >4 cm, T3, T4, or N2) were treated with primary chemotherapy comprising cyclophosphamide, vincristine, doxorubicin, and prednisolone and then surgery (either conservation or mastectomy with axillary surgery) followed by radiotherapy were examined.Results: The clinical response rate of these patients was 75% (21% complete and 54% partial), with a complete pathological response rate of 15%. A total of 10 patients (6%) experienced local disease relapse, and the median time to relapse was 14 months (ranging from 3 to 40). The median survival in this group was 27 months (ranging from 13 to 78). In patients having breast conservation surgery, local recurrence occurred in 2%, and in those undergoing mastectomy 7% experience local relapse of disease. Factors predicting patients most likely to experience local recurrence were poor clinical response and residual axillary nodal disease after chemotherapy.Conclusions: Excellent local control of disease can be achieved in patients with large and locally advanced breast cancers using a combination of primary chemotherapy, surgery and radiotherapy. However, the presence of residual tumor in the axillary lymph nodes after chemotherapy is a predictor of local recurrence and patients with a better clinical response were also less likely to experience local disease recurrence. The size and degree of pathological response did not predict patients most likely to experience recurrence of disease. (C) 2003 Excerpta Medica, Inc. All rights reserved.

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KW - recurrence

KW - primary chemotherapy

KW - LYMPH-NODE STATUS

KW - NEOADJUVANT CHEMOTHERAPY

KW - RANDOMIZED TRIAL

KW - PREOPERATIVE CHEMOTHERAPY

KW - RADIATION-THERAPY

KW - AVOID MASTECTOMY

KW - TUMOR RECURRENCE

KW - CARCINOMA

KW - MANAGEMENT

KW - SURVIVAL

U2 - 10.1016/S0002-9610(03)00078-3

DO - 10.1016/S0002-9610(03)00078-3

M3 - Article

VL - 185

SP - 525

EP - 531

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 6

ER -