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Combination chemotherapy and systemic irradiation consolidation for poor prognosis breast cancer
Author(s) -
Livingston Robert B.,
Schulman Susan,
Griffin Brian R.,
Tranum Bill L.,
Rivkin Saul E.,
Goldberg Ronald S.,
Fabian Carol J.,
Hammond Neel,
Hynes Henry
Publication year - 1987
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19870401)59:7<1249::aid-cncr2820590703>3.0.co;2-k
Subject(s) - medicine , cyclophosphamide , total body irradiation , chemotherapy , breast cancer , radiation therapy , surgery , oncology , doxorubicin , cancer
Seventy patients with poor prognosis, metastatic breast cancer were treated with FUVAC induction chemotherapy (5‐fluorouracil, vinblastine, Adriamycin [doxorubicin] and cyclophosphamide). Consolidation therapy was given to 30 of 48 responders (63%), of whom 23 received sequential hemibody irradiation (HBI) at 8 cGy, corrected in the upper half for lung transmission. Seven received high dose cyclophosphamide and total body irradiation (TBI) with subsequent infusion of stored, cryopreserved autologous bone marrow. The response rate to induction therapy was 71% (complete [CR] in 21%). The median survival for all patients entered in this study is 12 months. With consolidation, one CR patient who received cyclophosphamide and TBI is disease free at 20+ months, off all treatment, while HBI did not produce longterm remissions. Of 17 partial (PR) patients, two of 12 improved to CR with HBI, and one of five improved with cyclophosphamide plus TBI, but all ultimately relapsed. The main toxicity of sequential HBI was myelosuppression, with prolonged thrombocytopenia in 13%; only one case of radiation pneumonitis occurred (3%). Cyclophosphamide and TBI produced temporary, reversible marrow aplasia without other major toxicity. We recommend further investigation of Cytoxan (Bristol Myers Oncology Division, Evansville, IN) and TBI for breast cancer patients in remission after chemotherapy.