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Neoadjuvant chemo can eradicate axillary lymph node metastases before surgery for breast cancer
WESTPORT, Aug 03 (Reuters Health) - Neoadjuvant chemotherapy appears to be effective in eradicating breast cancer axillary lymph node metastases prior to surgery, according to study findings reported in the July issue of Annals of Surgery.
Dr. Henry M. Kuerer, now at the University of California, San Francisco, and colleagues at the University of Texas M. D. Anderson Cancer Center, in Houston report on a subpopulation of patients with locally advanced breast cancer and axillary lymph node metastases who responded to four cycles of a doxorubicin-based neoadjuvant chemotherapy.
They studied 191 patients with locally advanced breast cancer and cytologically confirmed nodal metastases. All patients received four cycles of 5-fluorouracil, doxorubicin and cyclophosphamide.
The research team determined that 43 patients, or 23%, had a complete histologic response to chemotherapy, defined as "...no evidence of residual invasive tumor in the breast or [axillary lymph nodes]." The 5-year disease-free survival rate for patients with complete response was 87% as opposed to 51% for those with residual nodal disease, the team found.
"On univariate analysis, patients with complete versus incomplete histologic axillary conversion were more likely to have initial estrogen-receptor-negative tumors, smaller primary tumors, and a complete pathologic response in the primary tumor," Dr. Kuerer's group reports.
From 39 of the 43 complete responders, the investigators obtained additional tissue specimens and performed immunohistochemical staining. They found occult nodal metastases in four patients, or 10% of all patients with histologically negative axilla. There was no significant difference in overall or disease-free survival rate between patients with occult nodal metastases and those without.
"The results of this study have implications for the potential use of sentinel lymph node biopsy as an alternative to axillary dissection in patients treated with neoadjuvant chemotherapy," the authors conclude.
Dr. Kuerer told Reuters Health that the response of some patients to neoadjuvant chemotherapy "...was really shocking, especially to a surgeon...that you could have such a dramatic effect without having to do such a radical operation."
The study findings imply, Dr. Kuerer said, that eventually the need for surgery may be eliminated for some patients with locally advanced breast cancer and nodal metastases. More immediately, he added, the results have implications "...for the management of the axilla with respect to complications of surgery such as lymphoedema, numbness and the [ongoing] risk of infection in the arm."
Dr. Kuerer noted in the interview that "...the technique is currently being evaluated in earlier-stage disease as well." Results from the National Surgical Adjuvant Breast and Bowel Study should be available in about 2 years, he said.
Ann Surg 1999;220:72-78.
-Westport Newsroom 203 319 2700
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