Summary
This study aimed to evaluate patterns of local and distant disease recurrence in patients having primary chemotherapy and compared patterns of relapse in patients with a complete pathological response with those who had residual breast disease. This is an observational study using a sequential series of patients treated with primary chemotherapy. They were followed up for a minimum of 5 years. All data was collected prospectively. Three hundred forty-one consecutive patients with breast cancer were treated with up to eight cycles of doxorubicin-based chemotherapy. Clinical and pathological response rates were evaluated and patients were followed up for disease recurrence (local and distant) and overall survival. Fifty-two patients (16.5%) had a complete pathological response to chemotherapy. Distant disease recurrence occurred in nine patients (17.3%) but no local recurrence was observed. In patients not having a complete pathological response, 86 patients (32.6%) subsequently developed metastases. Local recurrence of disease occurred in 12 (4.5%). There was a statistically significant difference in overall survival between patients whose tumours had a complete pathological response compared with patients who had residual disease in the breast following chemotherapy (88% versus 70% at 5 years, p = 0.036). Following primary chemotherapy, about 84% of patients had residual disease in the breast. Surgery is necessary to ensure complete removal of residual tumour and excellent rates of local control are achievable. A complete pathological response is associated with fewer local and distant recurrences as well as improved survival although there are no differences in time to development of metastatic relapse.
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M Lena ParticleDe R Zucali G Viganotti P Valagussa G Bonadonna (1978) ArticleTitleCombined chemotherapy–radiotherapy approach in locally advanced (T3b-T4) breast cancer Cancer Chemother Pharmacol 1 53–59 Occurrence Handle10.1007/BF00253147 Occurrence Handle373908
C Jacquillat M Weil F Baillet C Borel G Auclerc MA Maublanc Particlede M Housset G Forget L Thill C Soubrane (1990) ArticleTitleResults of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer Cancer 66 119–129 Occurrence Handle2112976
SM Scholl B Asselain T Palangie T Dorval M Jouve E Garcia Giralt J Vilcoq JC Durand P Pouillart (1991) ArticleTitleNeoadjuvant chemotherapy in operable breast cancer Eur J Cancer 27 1668–1671 Occurrence Handle1782080
A Eltahir SD Heys AW Hutcheon TK Sarkar I Smith LG Walker AK Ah-See O Eremin (1998) Am J Surg 175 127–132 Occurrence Handle10.1016/S0002-9610(97)00279-1 Occurrence Handle9515529
L Mauriac G MacGrogan A Avril M Durand A Floquet M Debled JM Dilhuydy F Bonichon (1999) ArticleTitleNeoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS) Ann Oncol 10 47–52 Occurrence Handle10.1023/A:1008337009350 Occurrence Handle10076721
SM Scholl A Fourquet B Asselain JY Pierga JR Vilcoq JC Durand T Dorval T Palangie M Jouve P Beuzeboc (1994) ArticleTitleNeoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6 Eur J Cancer 30A 645–652
VF Semiglazov EE Topuzov JL Bavli VM Moiseyenko OA Ivanova IK Seleznev AA Orlov NY Barash OM Golubeva OF Chepic (1994) ArticleTitlePrimary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb-IIIa breast cancer Ann Oncol 5 591–595 Occurrence Handle7993833
TJ Powles TF Hickish A Makris SE Ashley ME O’Brien VA Tidy S Casey AG Nash N Sacks D Cosgrove (1995) ArticleTitleRandomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer J Clin Oncol 13 547–552 Occurrence Handle7884414
A Makris TJ Powles SE Ashley J Chang T Hickish VA Tidy AG Nash HT Ford (1998) ArticleTitleA reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer Ann Oncol 9 1179–1184 Occurrence Handle10.1023/A:1008400706949 Occurrence Handle9862047
B Fisher J Bryant N Wolmark E Mamounas A Brown ER Fisher DL Wickerham M Begovic A DeCillis A Robidoux RG Margolese AB Cruz SuffixJr JL Hoehn AW Lees NV Dimitrov Bear (1998) ArticleTitleEffect of preoperative chemotherapy on the outcome of women with operable breast cancer J Clin Oncol 16 2672–2685 Occurrence Handle9704717
IC Smith SD Heys AW Hutcheon ID Miller S Payne FJ Gilbert AK Ah-See O Eremin LG Walker TK Sarkar SP Eggleton KN Ogston (2002) ArticleTitleNeoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel J Clin Oncol 20 1456–1466 Occurrence Handle10.1200/JCO.20.6.1456 Occurrence Handle11896092
SD Heys AW Hutcheon TK Sarkar KN Ogston ID Miller S Payne I Smith LG Walker O Eremin (2002) ArticleTitleNeoadjuvant docetaxel in breast cancer: 3-year survival results from the Aberdeen trial Clin Breast Cancer 3 IssueIDsuppl 2 S69–S74 Occurrence Handle12435290
WG Cance LA Carey BF Calvo C Sartor L Sawyer DT Moore J Rosenman DW Ollila M Graham SuffixII (2002) ArticleTitleLong-term outcome of neoadjuvant therapy for locally advanced breast carcinoma: effective clinical downstaging allows breast preservation and predicts outstanding local control and survival Ann Surg 236 295–303 Occurrence Handle10.1097/00000658-200209000-00006 Occurrence Handle12192316
A Ring A Webb S Ashley WH Allum S Ebbs G Gui NP Sacks G Walsh IE Smith (2003) ArticleTitleIs surgery necessary after complete clinical remission following neoadjuvant chemotherapy for early breast cancer? J Clin Oncol 21 4540–4545 Occurrence Handle10.1200/JCO.2003.05.208 Occurrence Handle14673041
SA McIntosh KN Ogston S Payne ID Miler TK Sarkar AW Hutcheon SD Heys (2003) ArticleTitleLocal recurrence in patients with large and locally advanced breast cancer treated with primary chemotherapy Am J Surg 185 525–531 Occurrence Handle10.1016/S0002-9610(03)00078-3 Occurrence Handle12781879
AB Miller B Hoogstraten M Staquet A Winkler (1981) ArticleTitleReporting results of cancer treatment Cancer 47 207–214 Occurrence Handle7459811
AW Hutcheon SD Heys TK Sarkar (2003) ArticleTitleNeoadjuvant docetaxel in locally advanced breast cancer Breast Cancer Res Treat 79 IssueIDsuppl 1 S19–S24 Occurrence Handle10.1023/A:1024333725148 Occurrence Handle12868802
B Fisher S Anderson J Bryant RG Margolese M Deutsch ER Fisher JH Jeong N Wolmark (2002) ArticleTitleTwenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer N Engl J Med 347 1233–1241 Occurrence Handle10.1056/NEJMoa022152 Occurrence Handle12393820
U Veronesi N Cascinelli L Mariani M Greco R Saccozzi A Luini M Aguilar E Marubini (2002) ArticleTitleTwenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer N Engl J Med 347 1227–1232 Occurrence Handle10.1056/NEJMoa020989 Occurrence Handle12393819
V Londero M Bazzocchi C Del Frate F Puglisi C Di Loreto G Francescutti C Zuiani (2004) ArticleTitleLocally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy Eur Radiol 14 1371–1379 Occurrence Handle10.1007/s00330-004-2246-z Occurrence Handle14986052
A Rieber HJ Brambs A Gabelmann V Heilmann R Kreienberg T Kuhn (2002) ArticleTitleBreast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy Eur Radiol 12 1711–1719 Occurrence Handle10.1007/s00330-001-1233-x Occurrence Handle12111062
A Khan A Dickler E Marcus J Coon A Ali A Babbo S Gupta-Burt (2003) ArticleTitleClinical outcome correlation of positron emission tomography (PET) in patients with locally advanced breast cancer (LABC) treated with neoadjuvant doxorubicin and docetaxel Int J Radiat Oncol Biol Phys 57 IssueIDsuppl S167 Occurrence Handle10.1016/S0360-3016(03)00949-0
EF Vines C Pechoux ParticleLe R Arriagada (2003) ArticleTitleProphylactic cranial irradiation in small cell lung cancer Semin Oncol 30 38–46 Occurrence Handle10.1053/sonc.2003.50013
N Wolmark J Wang E Mamounas J Bryant B Fisher (2001) ArticleTitlePreoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18 J Natl Cancer Inst Monogr 30 96–102
M Colleoni D Zahrieh RD Gelber G Viale A Luini P Veronesi M Intra V Galimberti G Renne A Goldhirsch (2003) ArticleTitlePreoperative systemic treatment: prediction of responsiveness Breast 12 538–542 Occurrence Handle10.1016/S0960-9776(03)00163-2 Occurrence Handle14659132
T Jarvinen K Holli T Kuukasjarvi JJ Isola (1998) ArticleTitlePredictive value of topoisomerase II alpha and other prognostic factors for epirubicin chemotherapy in advanced breast cancer Br J Cancer 77 2267–2273 Occurrence Handle9649144
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Chaturvedi, S., McLaren, C., Schofield, A.C. et al. Patterns of Local and Distant Disease Relapse in Patients with Breast Cancer Treated with Primary Chemotherapy: Do Patients with a Complete Pathological Response Differ from Those with Residual Tumour in the Breast?. Breast Cancer Res Treat 93, 151–158 (2005). https://doi.org/10.1007/s10549-005-4615-y
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DOI: https://doi.org/10.1007/s10549-005-4615-y