A pilot evaluation of alternating preoperative chemotherapy in the management of patients with locoregionally advanced breast carcinoma

Thomas M. Pisansky, Charles L. Loprinzi, Stephen S. Cha, Robert J. Fitzgibbons, Clive S. Grant, A. Curtis Hass, Nicholas F. Reuter, Lester E. Wold, James N. Ingle, Carl G. Kardinal

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


BACKGROUND. This prospective trial was conducted to evaluate the outcome of patients treated with preoperative and postoperative chemotherapy, mastectomy, and irradiation for locoregionally advanced breast carcinoma. METHODS. Between June 1986 and September 1990, 71 patients received 2 cycles of doxorubicin that alternated with 2 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil prior to mastectomy; irradiation was administered when the tumor was not amenable to surgical resection. Additional chemotherapy and tamoxifen, in hormone receptor-positive tumors, was used after mastectomy. Post-operative irradiation was given on a selective basis for patients at high risk for locoregional disease recurrence. RESULTS. Although 5 patients (7%) had disease progression, clinical partial or complete tumor response to preoperative chemotherapy was noted in 46 patients (65%). Sixty-eight patients (96%) underwent mastectomy. With a median follow-up of 52 months, the relapse-free and overall survival rates at 5 years were 42% and 57%, respectively. Locoregional tumor recurrence occurred in 14 patients (20%), and 28 patients (39%) developed metastatic disease. Menopausal status, clinical presentation (noninflammatory vs. inflammatory), and American Joint Committee on Cancer clinical stage were independent covariates associated with patient outcome. CONCLUSIONS. Preoperative alternating chemotherapy, with the selective use of irradiation, resulted in significant locoregional disease regression and the successful integration of mastectomy into the therapeutic strategy. Locoregional tumor control and relapse-free and overall survival estimates for the approach described herein compared favorably with other contemporary reports for this condition.

Original languageEnglish (US)
Pages (from-to)2520-2528
Number of pages9
Issue number12
StatePublished - Jun 15 1996


  • breast neoplasms
  • chemotherapy
  • mastectomy
  • neoplasm recurrence
  • pathology
  • prognosis
  • prospective studies
  • radiotherapy
  • survival rate

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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