Concurrent chemotherapy and radiotherapy for nonmetastatic, Stage IV breast cancer

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Abstract
Patients (22) with AJC Stage IV (nonmetastatic) breast cancer were treated with a combination of chemotherapy (5-Fu [5-fluorouracil], adriamycin, cytoxan) and radiotherapy (5000 rad to the breast and lymphatic areas plus a 1500-2000 rad boost to areas of gross disease). The median survival and disease-free survival for these patients were 28 mo. and 18 mo., respectively. The rates of local-regional failure and distant metastases were 45 and 73%, respectively. The acute toxicity with this combined treatment regime was acceptable. Chemotherapy dose reductions because of leukopenia or thrombocytopenia were not excessive: 5 patients required no dose reduction, 10 patients required dose reductions of less than 25%, and the remaining seven patients required reductions of 30-40%. All patients developed a confluent erythema and 40% developed small patches of moist desquamation. All skin reactions were completely healed with 3 wk of completion of irradiation. The 22 study patients treated with chemotherapy and radiotherapy were compared to a historical control group of 41 similarly staged patients who were treated with irradiation alone (no chemotherapy). The median disease-free survival of the study patients was 12 mo. longer than that of the control patients; however, the disease-free survival curves became superimposable after 2 yr. Also, there was no difference in the overall survival between these 2 groups. Three conclusions were derived from this pilot study: Radiotherapy and chemotherapy do not provide adequate local control for these locally advanced breast cancers, suggesting that surgery should be added to the local treatment. The acute toxicity of the combined chemotherapy and radiotherapy regime is acceptable. While chemotherapy may delay the onset of recurrence in patients with locally advanced breast cancer, it does not appear to be able to affect the ultimate rate of recurrence or the overall survival.