High dose chemotherapy as adjuvant treatment in operable breast cancer with 10 or more involved axillary lymph nodes

Background: it is well known that breast cancer patients with more than 10 a×illary lymph nodes involved have poor prognosis even with e×tensive adjuvant chemotherapy. To improve this poor outcome, high-dose adjuvant chemotherapy has been applied to the these patients. This study was intended to clarify the efficacy and usefulness of high dose adjuvant chemotherapy (HDC) for high-risk breast cancer patients and its efficacy was compared with conventional adjuvant chemotherapy (non-HDC group). Patients and Methods: Twelve patients with breast cancer involving more than 10 a×illary nodes received high-dose chemotherapy with peripheral progenitor-stem cell transplantation (PBSCT). This regimen consists of BCNU (carmustine) 130 mg/m 2×3, CBDCA (carboplantin) 500 mg/m 2×3 and CPA (chyclophosphamide) 50 mg/kg×2 after induction chemotherapy with 3 cycles of CE (chyclophosphamide 600 mg/m 2, epirubicin 60 mg/m 2). Results: Twelve patients completed the high-dose chemotherapy regimen as planned, no patient died of chemotherapy related to×icity. After a median follow-up period of 44 months, disease-free and overall survival at 48 months after the operation for 12 patients determined by Kaplan-Meier methods was 63 % and 83 %, respectively. Disease-free survival was superior in the high-dose chemotherapy group compared with the control group but a statistical difference was not observed. Conclusion: High-dose chemotherapy seems to be an effective and feasible treatment for high-risk breast cancer patients. However, the usefulness of high-dose adjuvant chemotherapy for high-risk breast cancer patients should be confirmed by a large-scale randomized trial.