Preoperative radio-chemotherapy in early breast cancer patients: Long-term results of a phase II trial

Purpose: This phase II trial aimed to investigate the efficacy of concurrent radio- (RI) and chemotherapy (CT) in the preoperative setting for operable, non-metastatic breast cancer (BC) not amenable to initial breast-conserving surgery (BCS). Patients and methods: From 2001 to 2003, 59 women were included. CT consisted of four cycles of 5-FU, 500 mg/m(2)/d, continuous infusion (d1-d5) and vinorelbine, 25 mg/m(2) (d1 and d6). Starting concurrently with the second cycle, RT delivered 50 Gy to the breast and 46 Gy to the internal mammary and supra/infra-clavicular areas. Breast surgery and lymph node dissection were then performed. Adjuvant treatment consisted of a 16 Gy boost to the tumor bed after BCS, FEC (four cycles of fluorouracil 500 mg/m(2), cyclophosphamide 500 mg/m(2), and epirubicin 100 mg/m(2), d1; d21) for pN1-3 and hormone-therapy for positive hormone receptors BC. Results: The in-breast pathological complete response rate was 27%. BCS was performed in 41(69%) pts. Overall and distant-disease free survivals at 5 years were respectively 88% [95% Cl 80-98] and 83% [95% Cl 74-93] whereas locoregional and local controls were 90% [95% Cl 82-97] and 97% [95% Cl 92-100]. Late toxicity (CTCAE-V3) was assessed in 51 pts (86%) with a median follow-up of 7 years [5-8]. Four (8%) experienced at least one grade III toxicities (one telangectasia and three fibroses). Cosmetic results, assessed in 35 of the 41 pts (85%) who retained their breasts, were poor in four pts (11%). Conclusion: Preoperative concurrent administration of RI and CT is an effective regimen. Long-term toxicity is moderate. This association deserves further evaluations in prospective trials. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 102 (2012) 82-88