THOMAS JEFFERSON UNIVERSITY RESEARCHERS PUBLISH STUDY IN JAN. 15 'CANCER'
Breast Conservation Is a Treatment Option for Locally Advanced Breast Cancer Following Induction Chemotherapy /ADVANCE/ PHILADELPHIA, Jan. 13 /PRNewswire/ -- A study of locally advanced breast cancer indicates that breast conservation -- lumpectomy and radiation therapy -- may be a treatment option for women with this disease, when surgery is preceded by induction chemotherapy to shrink tumors. The data, collected since 1979 at Thomas Jefferson University Hospital, further indicates that disease-free survival for these women may be increased from 20 percent to 80 percent under this protocol. The results of the study will be published in the Jan. 15 issue of the journal "Cancer." According to senior author Gordon F. Schwartz, M.D., professor of surgery at Jefferson and a specialist in diseases of the breast, induction chemotherapy achieves significant tumor regression in most women with locally advanced breast cancer. This regression permits subsequent breast conservation or mastectomy with a greater expectation of long-term success than has been traditionally achieved. Locally advanced breast cancer historically carries a dismal prognosis; only 20 percent of women with this cancer are disease-free after two years. Disease-free survival at two years for the women in this study was 81 percent. Within the guidelines of the study, 189 women with locally advanced breast cancer were treated with induction chemotherapy; 85 percent of those women responded to the chemotherapy. They were then treated with either mastectomy alone or lumpectomy, followed by irradiation and further chemotherapy. Despite the locally advanced nature of the cancer at the time of diagnosis, 39 percent of the women in the Jefferson study were able to preserve their breasts with outcomes thus far equivalent to that of the women treated by mastectomy. The women who were given the option of breast conservation had been carefully selected based on their response to the chemotherapy. "At one time, doctors considered women with these large tumors `incurable' or 'highly likely to be incurable,'" commented Schwartz. "While this type of disease accounts for 10 percent to 20 percent of the breast cancer population, it leaves women with few options for survival. When we began to change the sequence of treatment and administer the chemotherapy before the surgery, we saw that tumors were melting away," Schwartz explained. "As more and more women were staying well longer, we began to convert treatment for about one-third of the women from mastectomy to breast conservation." Induction chemotherapy is not a novel approach to the treatment of locally advanced breast cancer; however, this study by Schwartz and his Jefferson associates reports the largest American experience with breast conservation in patients with this disease. William F. Biermann, M.D., an oncologist in Jefferson's division of neoplastic diseases and co-author of the study, noted that induction chemotherapy has improved the duration and quality of life among the women in the study. He explained that the study's disease-free survival rates of 80 percent after two years, 61 percent after five years and 55 percent after 10 years are higher than expected. "Normally, people think of breast cancer as a disease for which something surgical is done first. With this study, we hope to generate confidence in using a therapy in which surgery is put on hold to permit the body time to respond to chemotherapy." Schwartz said the first objective of their work was to enhance the survival outcome for women with this disease. The second goal of gauging response and changing treatment has allowed the study to extend into the efficacy of breast conservation. "The observation that induction chemotherapy improves the outcome of these patients is a major advance. Breast conservation as an additional benefit was beyond the initial expectations of the investigators who pioneered induction chemotherapy." While data has been accumulated on patients since 1979, breast conservation as an option began to be offered in 1983. Since 1990, approximately three-fourths of the women who responded to chemotherapy have been treated with breast conservation, almost exactly reversing the earlier trend between 1983 and 1990. Regarding recurrence of disease, four women who had mastectomies experienced recurrence, subsequently undergoing radiation therapy. Two women have remained free of disease; the remaining two developed systemic disease. One patient in the breast conservation group has had local recurrence. Sandra Swain, M.D., director of the Comprehensive Breast Center at the Lombardi Cancer Research Center of Georgetown University, commented, "The data is exciting in that it shows survival among these women to be increased. What's especially important is that not every patient had to have a mastectomy." Swain, who has conducted similar studies and is currently developing statistics on induction chemotherapy and breast conservation for locally advanced breast cancer, noted that the results of this study indicate that this type of treatment should be considered a viable, therapeutic approach for women with locally advanced breast cancer. /delval/ -0- 1/13/94/1730 /CONTACT: Kellyann McDonnell or Carol Lynn Daly of Thomas Jefferson University, 215-955-6300, or after hours, 215-955-6060/
CO: Thomas Jefferson University ST: Pennsylvania IN: MTC SU:
MK-JM -- PH022 -- 1817 01/13/94 15:04 EST
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|Date:||Jan 13, 1994|
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