Treatment of five patients with severe thrombocytopenia due to extensive bone marrow involvement by metastatic breast carcinoma produced a successful hematologic response in each. Sequential therapy with high doses of prednisone (50 to 100 mg/day), followed by ovarian ablation prior to or at the time of adrenalectomy combined with fluorouracil, is the recommended regimen. An objective response to corticosteroids occurred within one month; after adrenalectomy, a second favorable hematologic response was noted. Three patients who had adrenalectomy combined with fluorouracil therapy had excellent and sustained remissions (greater than ten months). One patient who did not receive fluorouracil had a shorter remission (5 Vi months). All patients tolerated their high-dose corticosteroids, surgery, and chemotherapy well.
Sugarbaker PH, Skarin AT, Wilson RE. Thrombocytopenia From Metastatic Carcinoma of the BreastEffective Managements of Patients With This Complication. Arch Surg. 1973;107(4):523–527. doi:10.1001/archsurg.1973.01350220009004