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November 1986

Multimodal Therapy for Locally Advanced Breast Cancer

Author Affiliations

From the Departments of Surgery (Drs Morrow and Marti), Medical Oncology (Drs Braverman, Sand, and Forlenza), Pathology (Drs Thelmo and Mora), and Radiation Therapy (Dr Sohn), State University of New York—Health Science Center at Brooklyn.

Arch Surg. 1986;121(11):1291-1296. doi:10.1001/archsurg.1986.01400110081014

• Thirty-one women with stage III breast cancer were prospectively treated with two cycles of cyclophosphamide (Cytoxan), doxorubicin hydrochloride (Adriamycin), fluorouracil, and tamoxifen citrate followed by a simple mastectomy with level I axillary dissection. Postoperatively, four additional cycles of the combination chemotherapy alternating with three cycles of 1500 rad (15 Gy) to the chest wall and lymphatics were given. Seventy-seven percent of patients had a greater than 50% reduction in tumor size after the initial chemotherapy. No tumor size progressed during therapy, and a single patient remained inoperable. Pathologic findings revealed nine patients with only microscopic residual tumor. Nuclear vacuolization was present in 42.8% of tumor cells after chemotherapy vs 14.2% of cells before chemotherapy. The mean follow-up for the groups is 24.3 months. To date, nine patients have had recurrence with only one isolated local recurrence. This therapy is effective in reducing primary tumor size and allows a limited mastectomy to be done with minimal morbidity.

(Arch Surg 1986;121:1291-1296)

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