Aggressive combined modality therapy for advanced local-regional breast carcinoma.

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Abstract
Women (32) with advanced local regional breast carcinoma, including 9 patients with histologically diagnosed inflammatory cancer, were entered on a prospective pilot study. They were treated aggressively with initial surgery, 2 courses of induction chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil, .+-. prednisone, .+-. tamoxifen (CMF [P] [T]), local-regional radiotherapy, and then maintenance chemotherapy with CMF(P) (T) alternating with doxorubicin, vincristine, .+-. tamoxifen (AV[T]). The patients have been followed for 19-70 mo. from the time of mastectomy and their actuarial 3-yr survival is 65% with a median survival that has not yet been reached. Median disease-free survival (time to progression) is currently 29.5 mo. Women whose gross disease could not be totally resected surgically had shorter disease-free survivals than those rendered surgically free of disease (P = 0.01). Clinically evident cardiotoxicity was seen in 25% of the patients and was felt to be primarily due to the combination of doxorubicin and radiation therapy. It was significantly more common (Plt < 0.05) in patients with left chest irradiation (7 of 18 women) as opposed to those with right-sided irradiation (1 of 14).