Salvage Treatments in Relapsing Resectable Breast Cancer

Abstract

There is convincing evidence that the natural history of resectable breast cancer can be perturbed by adjuvant medical intervention. In fact, a highly significant reduction in the recurrence rate has been documented, which was reflected in a highly significant reduction in the odds of death following adjuvant chemotherapy, especially in premenopausal women (Bonadonna and Valagussa 1988; Consensus Conference 1985; Henderson 1987). Nonetheless, despite improvements in primary treatments, a considerable proportion of women who receive adjuvant therapy subsequently develop recurrent disease. The proper management of these patients, can present a therapeutic problem. In fact, the prognostic variables at the time of first treatment failure can be considerably different as far as disease-free interval, the anatomical extent of recurrence, patient performance status, menopausal and steroid-receptor status are concerned. Limited case series have been reported so far in medical literature (Bitran et al. 1983; Buzdar et al. 1981; Chlebowsky et al. 1981; Morris et al. 1985; Wendt et al. 1980), and all concerned women who relapsed after adjuvant chemotherapy. The conclusions about the efficacy of salvage therapy have been somewhat contradictory; controversies also exist about whether previous adjuvant therapy, especially chemotherapy, could adversely affect survival after recurrence (Brincker et al. 1987).

Supported in part by Contract NO1-CM-07338 with the Division of Cancer Treatment, National Cancer Institute, National Institutes of Health.