Primary chemotherapy in operable breast cancer: Eight-year experience at the Milan Cancer Institute

Gianni Bonadonna, Pinuccia Valagussa, Cristina Brambilla, Laura Ferrari, Angela Moliterni, Monica Terenziani, Milvia Zambetti

Research output: Contribution to journalArticle


Purpose: Primary chemotherapy was administered to patients with tumors that measured ≤ 2.5 cm in largest diameter to decrease the size of the primary tumor and allow for effective local and distant control while avoiding mastectomy. Patients and Methods: Two prospective nonrandomized studies were performed that used different regimens of primary chemotherapy followed by breast-sparing surgery in the presence of objective tumor remission. Additional postoperative chemotherapy was given to women at high risk of disease relapse. The median follow-up duration was 65 months. Results: A total of 536 assessable patients were enrolled, and the main characteristics were fairly comparable between the two trials. Following primary chemotherapy, 85% of patients could be subjected to breast-sparing surgery; in 14 patients (3%), surgical specimens failed to show any residual neoplastic cell. In the final multivariate analysis, the histologically assessed extent of axillary node involvement (P <.001), as well as degree of response to primary chemotherapy (P = .034), represented the significant variables able to influence 8-year relapse-free survival. In women subjected to a breast-conserving approach, the cumulative risk of local relapse as first event alone was 6.8% (95% confidence interval, 3.9% to 8.8%). Conclusion: Current findings indicate that primary chemotherapy can be safely administered in women with large tumors (>5.0 cm) and can allow breast- sparing surgery in a high fraction of patients (62%). However, to assess effectively the worthiness of this approach on long-term results, properly conceived large randomized studies with newer and more effective drug regimens are warranted.

Original languageEnglish
Pages (from-to)93-100
Number of pages8
JournalJournal of Clinical Oncology
Issue number1
Publication statusPublished - Jan 1998

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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