Chemotherapy Before Surgery Recommended for Locally Advanced Breast Cancer

Locally advanced breast cancer is best treated with chemotherapy before surgery, according to researchers at the University of North Carolina at Chapel Hill.

Results from a breast cancer treatment study begun in 1992 show that long-term survival occurs more often in women who have had chemotherapy followed by surgery for the treatment of large, locally advanced tumors.

Traditional treatment calls for women to have surgery first, followed by chemotherapy. New findings show that chemotherapy followed by surgery often requires less drastic surgery.

The study consisted of 62 women with locally advanced primary breast tumors greater than five centimeters, with skin or chest wall involvement or with extensive involvement of the armpit lymph nodes. The average age of the women was 44; two-thirds of the women were white and one-third was black.

Over a period of 70 months, 76 percent of the patients included in the study who received chemotherapy before surgery survived for at least five years, according to the study presented at the 122nd Annual Meeting of the American Surgical Association in Hot Springs, Virginia.

A total of 84 percent of the women showed a significant clinical response to the chemotherapy. Forty-five percent of the women had sufficient downstaging of their tumor to allow an attempt at breast conserving surgery. Only the women with cancer in the margins of surgery after lumpectomy and those with inflammatory breast disease were unable to have the breast conserving surgery.

Being treated with chemotherapy before surgery may make surgery a more viable option for women whose tumors were considered inoperable due to their advanced stage, according to Dr. William G. Cance, professor of surgery and chief of surgical oncology and presenter of the study.

"These data provide evidence that breast conservation therapy can reasonably be accomplished in up to 45 percent of patients with non-inflammatory locally advanced breast cancer," said Cance. "Furthermore, the tumor response to chemotherapy can help identify the subgroup of patients with a more favorable long-term prognosis. Those patients who have clinical downstaging of their tumors and are candidates for breast conserving therapy have the best long-term outcome."

Cance believes that aggressive treatment with chemotherapy before surgery should be standard care for patients with locally advanced breast cancer.

Other Sources: University of North Carolina School of Medicine