B Overall survival. Exploratory Cox regression mod- eling suggested that the relationship of distant disease—free sur- vival with posttreatment AJCC stage may be more closely Survival associated with number of involved nodes N than with extent of residual breast tumor T in this high-risk population.
All P values are two-sided order-restricted version of the log-rank test; i. We applied each system to our The Milan Cancer Institute classification system described by data set to evaluate their usefulness for detecting associations Bonadonna et al. This clas- non-response i. Anderson classification system 3 discriminates stage 0 category of the revised AJCC TNM in that the for- between no invasive tumor in breast or axillary lymph nodes mer but not the latter includes patients who have residual nodal i.
Patients whose residual tumors were classified as patho- breast or axillary lymph nodes. Denominators represented total patients in that response classification system category.
This staging method is simple to breast conservation surgery regardless of their response to use because it requires only the pathology report. Furthermore, treatment. Compared with patients who were not considered this method categorizes patients into more than two groups, candidates for breast conservation surgery, patients who were allowing determination of prognostic groups with excellent, inter- considered candidates for breast conservation surgery had statis- mediate, and extremely poor outcomes.
Table 5 demonstrates how patients in each of mately half of the patients in our study received further chemo- the AJCC categories would be classified according to these other therapy following surgery did not appear to substantially diminish four systems.
The use of after neoadjuvant chemotherapy are associated with relapse and adjuvant tamoxifen was also not related to outcome. It is possible survival 1—3. Because of its value as a surrogate for survival, that this lack of association simply reflects the heterogeneous response to neoadjuvant chemotherapy is used as a primary end- population of hormone receptor—negative and —positive tumors; it point in studies that examine the efficacy of new drugs and novel is also possible that 5 years of follow up suffices to measure the drug combinations.
However, there is no standard classification impact of chemotherapy but not that of endocrine therapy. We also applied several other response classification methods Moreover, many of the response classification systems currently to our data set. Only two methods—the method used at the Milan in use employ different combinations of pathologic results and Cancer Institute 6 and the method used in our previous work clinical response assessment.
Because of this lack of a standard, 2 —provided statistically significant prognostic ability for both accurate, and reliable response classification system, most stud- distant disease—free survival and overall survival. The method ies that have reported results of neoadjuvant regimens have used used at the Milan Cancer Institute incorporates pathologic results pathologic complete response as a surrogate for survival. The method used at M.
Anderson 3 , which distin- had a pathologic complete response. The method used previously at the University staging after a patient receives neoadjuvant chemotherapy. We of North Carolina was easily performed and provided statisti- found that the revised AJCC TNM staging system was an cally significant prognostic ability for both distant disease—free effective and easy way to measure the extent of pathologic and overall survival; however, it is limited in its usefulness Journal of the National Cancer Institute, Vol.
Although the pathologic make it difficult to evaluate the impact of additional adjuvant complete response category was prognostic, the trend test for the chemotherapy or tamoxifen. For this reason, regimens for early-stage residual disease categories. For all of these methods, pathologic breast cancer are increasingly being tested in neoadjuvant complete response was prognostic but prognostic ability was chemotherapy trials. The lack of an accurate, simple, and highly limited because of the small number of patients who achieved discriminating method to assess the intermediate endpoint of this endpoint.
The AJCC system that we examined is simple and patients who have received neoadjuvant chemotherapy is an ex- reproducible and, in our cohort, accurately predicted both good cellent prognostic factor 5,7,8 and is often used as an interme- and poor distant disease—free survival and overall survival.
Other theoretical direc- tions for neoadjuvant therapy should also be considered. J Clin Oncol ;— Ann Surg ;—; discussion insufficient—is a worthwhile and achievable goal. This latter —3. NSABP B 7 and Aberdeen 8 trials, in which patients who Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant were randomly assigned to receive a non—cross-resistant regimen chemotherapy.
J Clin Oncol ;—9. AJCC cancer staging logic complete response than did patients who were randomly manual. New York NY :Springer; Re- the improved pathologic complete response rate was associated sponse to trastuzumab Herceptin given with paclitaxel Taxol immediately with improved relapse—free and overall survival 8. The patho- following 4AC as initial therapy for primary breast cancer. Breast Cancer Res Treat ; Primary chemotherapy in operable breast cancer: eight-year experience of disease at diagnosis; response classification systems as inter- at the Milan Cancer Institute.
JCO disease recurrence or death and may therefore be candidates for ;— Therapeutic exploitation of this approach will require improved clinical and radiographic methods to identify residual disease.
The authors thank Matthew G. This study is limited by several factors. The data set is small Ewend, MD, for his critical review and Ms. Shanah Kirk for her assistance with and derives from a heterogeneously treated and high-risk pop- the production of this manuscript. This work was presented in part at the 39th ulation treated with aggressive multimodality therapy.
The size and May 26, Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs.
Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.
In most cases, chemo has the greatest effect when more than one drug is used at a time. Often, combinations of 2 or 3 drugs are used. Doctors use many different combinations, and it's not clear that any particular drug combination is the best.
Although drug combinations are often used to treat early breast cancer, advanced breast cancer often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat metastatic breast cancer.
See Targeted Therapy for Breast Cancer for more information about these drugs. Chemo drugs for breast cancer are typically given into a vein IV , either as an injection over a few minutes or as an infusion over a longer period of time. Often, a slightly larger and sturdier IV is required in the vein system to administer chemo.
They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing. There are many different kinds of CVCs. The most common types are the port and the PICC line. For breast cancer patients, the central line is typically placed on the side opposite of the breast cancer. If a woman has breast cancer in both breasts, the central line will most likely be placed on the side that had fewer lymph nodes removed or involved with cancer.
Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Chemo cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, chemo is given only on the first day of the cycle. With others, it is given one day a week for a few weeks or every other week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for metastatic Stage 4 breast cancer depends on how well it is working and what side effects you have. Doctors have found that giving the cycles of certain chemo drugs closer together can lower the chance that the cancer will come back and improve survival for some women with breast cancer. For example, a drug that would normally be given every 3 weeks might be given every 2 weeks.
This can be done for both neoadjuvant and adjuvant treatment. For example, a chemo combination sometimes given this way is doxorub i cin Adriamycin and cyclophosphamide Cytoxan every 2 weeks, followed by paclitaxel Taxol every 2 weeks. Chemo drugs can cause side effects, depending on the type and dose of drugs given, and the length of treatment. Some of the most common possible side effects include:. These side effects usually go away after treatment is finished.
There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting. Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting.
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause not having any more menstrual periods and infertility not being able to become pregnant may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss. Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment.
When women have finished treatment like chemo , they can safely go on to have children, but it's not safe to get pregnant while being treated. If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone LHRH analog , along with chemo, can help them have a successful pregnancy after cancer treatment.
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