Pre-operative chemotherapy and radiotherapy in breast cancer

M. Colleoni, F. Nole', I. Minchella, C. Noberasco, A. Luini, A. Orecchia, P. Veronesi, S. Zurrida, G. Viale, A. Goldhirsch

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Primary systemic treatment of breast cancer with cytotoxics yields a high response rate and allows conservative surgical procedures in bulky tumours. In order to maximise local control of disease, two innovations were introduced in a pilot study. The first was to identify the good responders after three cycles of chemotherapy and to treat them with three additional cycles. The second was to also give this group of patients a full dose of radiotherapy before surgery with the aim of verifying the rate of pathological complete remissions in view of a possible treatment of breast primary with chemoradiotherapy only. Patients were treated with doxorubicin 60 mg/m 2 and cyclophosphamide, 600 mg/m 2 both intravenously on day 1, every 21 days for three courses. Partial or complete responders received three more courses followed by radiotherapy (50 Gy plus a 10 Gy boost). The others underwent immediate surgery. A total of 32 patients (median age, 50 years; range 28-69 years); performance status, 0-1; T 2 22, T 3 8, T 4 2) were enrolled and were evaluable for response and side-effects. 9 patients had only three cycles of chemotherapy due to absence of response and 23 patients had six cycles of chemotherapy. Overall, 7 patients had a complete remission, 16 a partial remission and 9 had stable disease, for an overall response rate of 72% (95% confidence interval 53-86%). In the group of patients that completed the programme, two complete pathological remissions were observed and 5 patients had only microfoci of tumour. No toxic death or grade III-IV toxicities were observed. Mild or moderate side-effects included mucositis, nausea/vomiting and leucopenin. In conclusion, our results indicate that the addition of radiotherapy to pre-operative chemotherapy did not significantly enhance the incidence of pathological complete remissions. New primary treatment approaches should be explored in this subset of patients in order to improve outcome.

Original languageEnglish
Pages (from-to)641-645
Number of pages5
JournalEuropean Journal of Cancer
Volume34
Issue number5
DOIs
Publication statusPublished - Apr 1998

Fingerprint

Radiotherapy
Breast Neoplasms
Drug Therapy
Mucositis
Poisons
Chemoradiotherapy
Doxorubicin
Cyclophosphamide
Nausea
Vomiting
Neoplasms
Breast
Therapeutics
Confidence Intervals
Incidence

Keywords

  • Breast cancer
  • Chemotherapy
  • Neoadjuvant
  • Radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

Cite this

Pre-operative chemotherapy and radiotherapy in breast cancer. / Colleoni, M.; Nole', F.; Minchella, I.; Noberasco, C.; Luini, A.; Orecchia, A.; Veronesi, P.; Zurrida, S.; Viale, G.; Goldhirsch, A.

In: European Journal of Cancer, Vol. 34, No. 5, 04.1998, p. 641-645.

Research output: Contribution to journalArticle

@article{3b423550250a40fc8d18ef473e217be6,
title = "Pre-operative chemotherapy and radiotherapy in breast cancer",
abstract = "Primary systemic treatment of breast cancer with cytotoxics yields a high response rate and allows conservative surgical procedures in bulky tumours. In order to maximise local control of disease, two innovations were introduced in a pilot study. The first was to identify the good responders after three cycles of chemotherapy and to treat them with three additional cycles. The second was to also give this group of patients a full dose of radiotherapy before surgery with the aim of verifying the rate of pathological complete remissions in view of a possible treatment of breast primary with chemoradiotherapy only. Patients were treated with doxorubicin 60 mg/m 2 and cyclophosphamide, 600 mg/m 2 both intravenously on day 1, every 21 days for three courses. Partial or complete responders received three more courses followed by radiotherapy (50 Gy plus a 10 Gy boost). The others underwent immediate surgery. A total of 32 patients (median age, 50 years; range 28-69 years); performance status, 0-1; T 2 22, T 3 8, T 4 2) were enrolled and were evaluable for response and side-effects. 9 patients had only three cycles of chemotherapy due to absence of response and 23 patients had six cycles of chemotherapy. Overall, 7 patients had a complete remission, 16 a partial remission and 9 had stable disease, for an overall response rate of 72{\%} (95{\%} confidence interval 53-86{\%}). In the group of patients that completed the programme, two complete pathological remissions were observed and 5 patients had only microfoci of tumour. No toxic death or grade III-IV toxicities were observed. Mild or moderate side-effects included mucositis, nausea/vomiting and leucopenin. In conclusion, our results indicate that the addition of radiotherapy to pre-operative chemotherapy did not significantly enhance the incidence of pathological complete remissions. New primary treatment approaches should be explored in this subset of patients in order to improve outcome.",
keywords = "Breast cancer, Chemotherapy, Neoadjuvant, Radiotherapy",
author = "M. Colleoni and F. Nole' and I. Minchella and C. Noberasco and A. Luini and A. Orecchia and P. Veronesi and S. Zurrida and G. Viale and A. Goldhirsch",
year = "1998",
month = "4",
doi = "10.1016/S0959-8049(97)10091-0",
language = "English",
volume = "34",
pages = "641--645",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Ltd",
number = "5",

}

TY - JOUR

T1 - Pre-operative chemotherapy and radiotherapy in breast cancer

AU - Colleoni, M.

AU - Nole', F.

AU - Minchella, I.

AU - Noberasco, C.

AU - Luini, A.

AU - Orecchia, A.

AU - Veronesi, P.

AU - Zurrida, S.

AU - Viale, G.

AU - Goldhirsch, A.

PY - 1998/4

Y1 - 1998/4

N2 - Primary systemic treatment of breast cancer with cytotoxics yields a high response rate and allows conservative surgical procedures in bulky tumours. In order to maximise local control of disease, two innovations were introduced in a pilot study. The first was to identify the good responders after three cycles of chemotherapy and to treat them with three additional cycles. The second was to also give this group of patients a full dose of radiotherapy before surgery with the aim of verifying the rate of pathological complete remissions in view of a possible treatment of breast primary with chemoradiotherapy only. Patients were treated with doxorubicin 60 mg/m 2 and cyclophosphamide, 600 mg/m 2 both intravenously on day 1, every 21 days for three courses. Partial or complete responders received three more courses followed by radiotherapy (50 Gy plus a 10 Gy boost). The others underwent immediate surgery. A total of 32 patients (median age, 50 years; range 28-69 years); performance status, 0-1; T 2 22, T 3 8, T 4 2) were enrolled and were evaluable for response and side-effects. 9 patients had only three cycles of chemotherapy due to absence of response and 23 patients had six cycles of chemotherapy. Overall, 7 patients had a complete remission, 16 a partial remission and 9 had stable disease, for an overall response rate of 72% (95% confidence interval 53-86%). In the group of patients that completed the programme, two complete pathological remissions were observed and 5 patients had only microfoci of tumour. No toxic death or grade III-IV toxicities were observed. Mild or moderate side-effects included mucositis, nausea/vomiting and leucopenin. In conclusion, our results indicate that the addition of radiotherapy to pre-operative chemotherapy did not significantly enhance the incidence of pathological complete remissions. New primary treatment approaches should be explored in this subset of patients in order to improve outcome.

AB - Primary systemic treatment of breast cancer with cytotoxics yields a high response rate and allows conservative surgical procedures in bulky tumours. In order to maximise local control of disease, two innovations were introduced in a pilot study. The first was to identify the good responders after three cycles of chemotherapy and to treat them with three additional cycles. The second was to also give this group of patients a full dose of radiotherapy before surgery with the aim of verifying the rate of pathological complete remissions in view of a possible treatment of breast primary with chemoradiotherapy only. Patients were treated with doxorubicin 60 mg/m 2 and cyclophosphamide, 600 mg/m 2 both intravenously on day 1, every 21 days for three courses. Partial or complete responders received three more courses followed by radiotherapy (50 Gy plus a 10 Gy boost). The others underwent immediate surgery. A total of 32 patients (median age, 50 years; range 28-69 years); performance status, 0-1; T 2 22, T 3 8, T 4 2) were enrolled and were evaluable for response and side-effects. 9 patients had only three cycles of chemotherapy due to absence of response and 23 patients had six cycles of chemotherapy. Overall, 7 patients had a complete remission, 16 a partial remission and 9 had stable disease, for an overall response rate of 72% (95% confidence interval 53-86%). In the group of patients that completed the programme, two complete pathological remissions were observed and 5 patients had only microfoci of tumour. No toxic death or grade III-IV toxicities were observed. Mild or moderate side-effects included mucositis, nausea/vomiting and leucopenin. In conclusion, our results indicate that the addition of radiotherapy to pre-operative chemotherapy did not significantly enhance the incidence of pathological complete remissions. New primary treatment approaches should be explored in this subset of patients in order to improve outcome.

KW - Breast cancer

KW - Chemotherapy

KW - Neoadjuvant

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=0032055261&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032055261&partnerID=8YFLogxK

U2 - 10.1016/S0959-8049(97)10091-0

DO - 10.1016/S0959-8049(97)10091-0

M3 - Article

VL - 34

SP - 641

EP - 645

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

IS - 5

ER -