One hundred seventy-one primary breast cancer patients were treated in 1997. Most patients underwent modified radical mastectomy or partial resection with axillary dissection. If parasternal lymph nodes raised a suspicion of metastasis, a transient muscle-splitting method was used for dissection instead of the extended radical mastectomy. The rate of breast-conserving treatment (BCT) was 27.4%. The indications for BCT have not been established. In addition, the local recurrence rate and overall survival rate based on long term follow-up after BCT have not been reported. In this hospital, patients who are eligible for BCT are informed of the method, benefits and risks of BCT, after which they choose BCT or mastectomy.
A recent meta-analysis indicated that adjuvant chemo-hormonal therapy for early breast cancer can prolong disease-free survival and overall survival. In Western countries, adjuvant polychemotherapy given intravenously is recommended for node-negative high-risk, or node-positive breast cancer patients. In contrast, monochemotherapy with oral fluoropyrimidine compounds (OFP) is widely used in Japan, because OFP is believed to be less toxic than polychemotherapy. The most important issue is whether OFP confers a greater survival benefit than polychemotherapy. To answer this question, clinical randomized trials organized by JCOG (Japan Clinical Oncology Group) and NSAS (National Surgical Adjuvant Study of Breast Cancer) are ongoing.
Of the 407 breast cancer patients who underwent radical mastectomy or BCT between June 1992 and December 1995, 60 (14.7%) had relapsed by December 1997. As to the clinicopathological findings of these patients, 10 or more nodal metastases were found to be the most powerful prognostic factor predicting relapse.
Ongoing Phase III trials
1. JCOG 9208: CAF+TAM vs. CAF+ high-dose CPA and thioTEPA with ABMT+TAM for patients with 10 or more positive nodes (1993-)
2. JCOG 9401: AC+TAM vs. TAM for postmenopausal women with one-to-nine positive nodes (1995-)
3. JCOG 9404: AC+TAM vs. UFT+TAM for premenopausal women with one-to-nine positive nodes (1995-)
4. NSAS-BC 01: CMF±TAM vs. UFT±TAM for node negative, high- risk patients (1996-) Note: [A; adriamycin, ABMT; autologous bone marrow transplantation, C or CPA; cyclophosphamide, F; 5-fluorouracil, M; methotrexate, TAM; tamoxifen, UFT; tegafur+uracil]
The feasibility of adjuvant chemotherapy for non-randomized breast cancer patients was reported. Cytotoxic polychemotherapy employing CMF or CA(F) resulted in greater toxicity than OFP, but was well tolerated and feasible in the adjuvant setting used in Japanese women from the viewpoint of anticancer agent toxicities.
Predictive factors related to the sensitivity of chemo-hormonal therapy have been investigated. Human proto-oncogene erbB-2, a prognostic factor for breast cancer, was also reported to be a factor predicting the cytotoxic effect of anthracycline. In this Division. the levels of cytosol and serum erbB-2 protein are routinely measured. The data obtained will be evaluated based on the outcomes of patients receiving adjuvant chemo-hormonal therapy.
|Standard radical mastectomy||3 (2%)|
|Modified radical mastectomy||117 (68%)|
|Breast-conserving surgery||47 (27%)|
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