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Current status and indications for adjuvant therapy in breast cancer

Summary

  1. 1.

    Modified radical mastectomy is the standard surgical procedure today in most countries. ‘Lesser surgery’ associated with radiotherapy emerges as an alternative for patients with T1N0 lesions.

  2. 2.

    The potential risk of occult micrometastases is best predicted by careful axillary staging and possibly by the ER status of the primary tumor.

  3. 3.

    Additonal risk factors such as tumor size, patient age, menopausal status, and intramammary lymphatic or vascular invasion are less well established and need clarification.

  4. 4.

    Previous studies showed no significant long-term benefit of adjuvant radiotherapy and at best a marginal increase of lifespan by adjuvant castration in patients subjected to radical surgery.

  5. 5.

    Various types of adequately intensive adjuvant chemotherapy resulted in a significant increase of relapse-free survival and probably also overall survival 5–6 years after mastectomy in pre- and possibly also postmenopausal N+ patients.

  6. 6.

    Treatment intensity (full doses) of adjuvant chemotherapy seems to be more critical than treatment duration (CMFx6 is as good as CMFx12).

  7. 7.

    Adjuvant chemotherapy with drug combinations is generally more effective than single drugs. No combination so far (if adequate doses are given) is clearly superior.

  8. 8.

    Whether early peri-operative onset of adjuvant chemotherapy or combinations with endocrine measures or cyclic, alternating drug regimens increase effectiveness remains to be shown.

  9. 9.

    Adjuvant chemotherapy in N- patients, though still experimental, appears rewarding.

  10. 10.

    The pattern of first relapse has not been significantly altered by the use of adjuvant chemotherapy. Response rate and duration with secondary treatments are consistent with common experience in metastatic disease.

  11. 11.

    Up to 5–6 years median observation time there is no proof that the risk of second neoplasms is increased by currently used adjuvant chemotherapy regimens.

  12. 12.

    More and highly critical prospective trials are needed to assess not only effectiveness, but also patient tolerance (cost-benefit ratio) of adjuvant therapies in breast cancer.

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This article is based on a paper presented in Session II: Symposium on the Current Status of Adjuvant Chemotherapy at the Twelfth International Congress of Chemotherapy, Florence, Italy, 20 July 1981

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Senn, H.J. Current status and indications for adjuvant therapy in breast cancer. Cancer Chemother. Pharmacol. 8, 139–150 (1982). https://doi.org/10.1007/BF00255474

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Keywords

  • Breast Cancer
  • Adjuvant Chemotherapy
  • Adjuvant Therapy
  • Menopausal Status
  • Radical Mastectomy