[Combination treatment of localised breast cancers with a high risk of metastatic disease. The results of a prospective controlled study (author's transl)].

74 patients who had adenocarcinoma of the breast that was inoperable at the beginning because of local extension but without inflammation and without diagnosable metastases (T3b, T4, N1, 2 or 3, Mo) were submitted to a therapeutic regime which consisted consecutively of: 1) preliminary chemotherapy, 2) radiotherapy and/or extended radical surgery when there was any residual tumour, and 3) follow-up adjuvant chemotherapy. Two types of combinations of cytostatic drugs were used: adriamycin, vincristin and methotrexate (AVM) for 5-day cycles every 3 weeks, and cyclophosphamide, methotrexate and fluoro-uracil (CMF) in 14-day cycles every 4 weeks. Three to 5 cycles of AVM were used initially, then at first either AVM to a total of 550 mg/m2 adriamycin, or a series of CMF carried on for a year. Complete remission was obtained in 70% of the patients (52 out of 74) at the end of the local-regional treatment. The mean time of remission was 33 months and the mean time of overall survival was 43 months. The best results were obtained in younger women (under 65 years of age) with tumours that were less developed (T3b), and who could take all the adjuvant chemotherapy after they had complete remission. There was no relapse in 37 of the 48 patients in this group (77% of the cases). Overall the treatment was tolerated fairly well and there was no major complication at the time of radiotherapy or surgery. These results are comparable to those from other studies of a similar nature and show a real progress as compared with those that used to be obtained when only local and regional treatments were undertaken. A more thorough follow-up is however necessary since we can hope for improvements to increase the efficacy and tolerance of the treatments, but this form of treatment can here and now be considered as an important factor for improving the survival rate of these very high risk patients.