Regional induction chemotherapy in locally advanced breast cancer

Abstract From May 1985 to May 1989 45 patients suffering from primary inflammatory breast cancer were entered in this Phase II trial of preoperative intra-arterial induction chemotherapy (IACT) using mitoxantrone. The aim of this study was to identify a rapid way of achieving operability without additional discomfort to the patient. IACT was performed supraselectively using digital subtraction angiography. After local operability has been achieved, a modified radical mastectomy was performed. Postoperatively, premenopausal patients were treated with adjuvant chemotherapy (CMF) and postmenopausal patients with tamoxifen for a period of two years. All tumours showed a good response 4 weeks after the start of treatment and by 8 weeks, 91% of all tumours were operable. Mammography showed tumour regression of more than 50% in almost 75% of the carcinomas. After a median follow-up of 37 months, the overall survival rate was 29% with a median survival time of 50 months. The median disease-free survival time was 24.4 months for all patients and 25% were alive and symptom free after 6 years. The response rate after induction IACT correlated with the number of cycles required to obtain a significant response, with patients treated with one cycle having a median survival time of 54 months, two cycles 39 months and a median survival time of 9 months in patients who had three cycles.