The use of chemotherapy initially to treat stage II to IIIA breast cancer may result in shrinkage of the tumor such that minimally invasive surgery (rather than more extensive surgery) may become a treatment option. This news comes by way of a recent study conducted by cancer researchers in Houston.

Breast cancer is characterized by the presence of cancer cells in the tissue or ducts of the breast. Depending on the stage of disease, treatment options may include surgery, chemotherapy, radiation therapy, and/or hormone therapy. Often, an important part of treatment for persons with cancer that has spread to the lymph nodes under the arm, called locally advanced breast cancer, is surgery to remove the cancer and surrounding tissue (lumpectomy) or to remove the whole breast (mastectomy). Recently, researchers have been studying the use of chemotherapy before surgery for early-stage breast cancers in order to shrink the cancer to a size at which surgery may be more successful or a less extensive surgery may be needed. This treatment strategy is referred to as downstaging the cancer. This is an important approach to treatment because many women who need surgery for breast cancer would prefer to have a less extensive, or breast-conserving surgery, rather than removal of the whole breast. However, cancers that are large in size or have spread to the lymph nodes sometimes require a mastectomy to remove the cancer and reduce the risk of cancer recurrence (return of cancer later). By using chemotherapy to shrink the cancer before surgery, it is hoped that more women will have the option of choosing a lumpectomy or other minimally invasive surgery, rather than a mastectomy, with a successful treatment outcome.

Researchers in Texas treated 129 women with stage II to IIIA breast cancer. The women, who had had no previous radiation therapy, completed 3 to 5 cycles of chemotherapy with either paclitaxel or a combination of fluorouracil, doxorubicin, and cyclophosphamide. The patients also underwent removal of some of the lymph nodes under the arm (called axillary lymph node dissection). Before the chemotherapy, the average tumor size was 4 centimeters; after the chemotherapy, the tumor size had shrunk to an average of 1.6 centimeters. The clinical response to the chemotherapy was 60%, with 24% having complete responses and 36% having partial responses. For those who had spread of cancer to the lymph nodes at diagnosis, examination of the lymph node cells after chemotherapy showed no detectable cancer in 34% and cancer in only 1 to 3 lymph nodes in 38%. The amount of tumor shrinkage was similar between the paclitaxel and fluorouracil/doxorubicin/cyclophosphamide groups.

The researchers concluded that chemotherapy with paclitaxel or with fluorouracil, doxorubicin, and cyclophosphamide is effective in shrinking the size of cancer in the breast and in the lymph nodes under the arm for women with stage II to IIIA breast cancer. While some women still had residual disease, the use of chemotherapy initially may allow the use of minimally invasive surgical procedures to remove the remaining cancer. Persons with breast cancer may wish to talk with their doctor about the risks and benefits of receiving chemotherapy before surgery or of participating in a clinical trial in which other promising new therapies are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (Cancer, Vol 88, No 6, pp 1417-1424, 2000)

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