Preoperative Chemotherapy: Advantages and Clinical Application in Stage III Breast Cancer

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Abstract
The inability to control the micrometastases present at the diagnosis of breast cancer (BC) accounts for most if not all of our present treatment failures. Even if only patients with localized breast cancer are considered, up to 40% will die of their tumor within 10 years (Nealon et al. 1979). The survival rate even for patients with the most favorable prognosis (with negative nodes) at 40 years is 53%, whereas the corresponding figure for those with positive nodes is 19% (Rutqvist and Wallgren 1982). In fact if all patients who develop breast cancer are followed until death, systemic breast cancer may be found to be the ultimate cause of death in as many as 90% of them (Mueller et al. 1978; Langlands et al. 1979; Henderson and Canellos 1980). In stage III (locally advanced) BC, from a practical standpoint all patients harbor micrometastases, and as a rule the end-result is death due to this disease (Papaioannou and Urban 1964; Pearlman et al. 1976; Osteen et al. 1978; Terz et al. 1978). Attempts to achieve more effective control of the latent systemic spread of BC are currently being made in many clinical trials based on various adjuvant regimens with cytostatic and/or hormonal agents. In practically all studies in which chemotherapy is used, treatment begins a few weeks after the operation. This policy of delaying treatment of the systeniic component of the disease until after operation may be disadvantageous however. A good reason for suspecting this is supplied by observations showing that in an experimental setting micrometastases begin to grow faster immediately after the primary focus is eliminated.