EARLY RECURRENCE IN FAVORABLE STAGE II BREAST CANCER - WHICH APPROACH IS THE BEST?

  • C. DIACONU ”Gr.T. Popa” University of Medicine and Pharmacy Iași
  • Camelia CHIFU ”Gr.T. Popa” University of Medicine and Pharmacy Iași
  • C. COSMAN ”Gr.T. Popa” University of Medicine and Pharmacy Iași
  • Roxana LIVADARIU ”Gr.T. Popa” University of Medicine and Pharmacy Iași
  • Irina FLOREA ”Gr.T. Popa” University of Medicine and Pharmacy Iași
  • L. MIRON ”Gr.T. Popa” University of Medicine and Pharmacy Iași
  • C. DOGARU ”Gr.T. Popa” University of Medicine and Pharmacy Iași
Keywords: STAGE II BREAST CANCER, CORE BIOPSY, TUMORAL MARKERS, NEOADJUVANT SYSTEMIC CHEMOTHERAPY

Abstract

Aim: Changing the sequence of therapeutic options in
stage II breast cancer: first, a core biopsy, followed by the evaluation of the tumoral markers,
adaptation of the chemotherapy scheme and finally, surgical approach. Thus would be possible
to improve the hope of life in some stage II breast cancer patients, in whom survival is poorer
than in some stage III patients. Material and method: 144 patients in stage II breast cancer
were included in this study, over a period of 5 years (2000-2004). In all these patients the first
therapeutic option was surgery (radically modified mastectomy type Madden), followed by
systemic chemotherapy-FAC or FEC, 6 cycles, and finally Tamoxifen. Results: 34 out of them
developed metastases in a period between 6 and 72 months, most of them in the first 26
months; 25 out of these 34 didnt have metastases in the axillary lymph nodes, and in 18
patients estrogen - and progesterone - receptors were highly positive. HER 2 neu was negative
or low expressed in patients with metastases. CD 34 wasnt evaluate in the whole group.
Conclusions: Early onset of metastases in the studied patients, in whom tumoral aggressiveness
markers were not obvious, impose the evaluation of the angiogenesis markers and, when
positive, chemotherapy as the first therapeutic option.

Author Biographies

C. DIACONU, ”Gr.T. Popa” University of Medicine and Pharmacy Iași

School of Medicine
Universitary Hospital ”St. Spiridon” Iași
III rd Surgery Clinic

Camelia CHIFU, ”Gr.T. Popa” University of Medicine and Pharmacy Iași

School of Medicine
Universitary Hospital ”St. Spiridon” Iași
III rd Surgery Clinic

C. COSMAN, ”Gr.T. Popa” University of Medicine and Pharmacy Iași

School of Medicine
Universitary Hospital ”St. Spiridon” Iași
III rd Surgery Clinic

Roxana LIVADARIU, ”Gr.T. Popa” University of Medicine and Pharmacy Iași

School of Medicine
Universitary Hospital ”St. Spiridon” Iași
III rd Surgery Clinic

Irina FLOREA, ”Gr.T. Popa” University of Medicine and Pharmacy Iași

School of Medicine
Universitary Hospital ”St. Spiridon” Iași

Department of Immunology

L. MIRON, ”Gr.T. Popa” University of Medicine and Pharmacy Iași

School of Medicine
Universitary Hospital ”St.. Spiridon” Iași

Department of Oncology

C. DOGARU, ”Gr.T. Popa” University of Medicine and Pharmacy Iași

School of Medicine
Universitary Hospital ”St. Spiridon” Iași
III rd Surgery Clinic

References

1. NCCN Clinical Practice Guidelines in Oncology; Breast Cancer 2008, www.nccn.org
2. Henderson IC, Berry DA, Demetry CD et al. Improved outcomes from adding sequential paclitaxel
but not from escalading doxorubicin dose in our adjuvant chemotherapy regime for patients with
node positive primary breast cancer. J Clin Oncol 2003; 21: 976-983
3. Fisher B, Bryant J, Wolmark N et al. Effect of preoperative chemotherapy on the outcome of
women with operable breast cancer. J Clin Oncol 1998; 16: 2672-2685.
4. Martin M, Pienkowsky T, Mackley J et al. Adjuvant docetaxel for node-positive breast cancer. N
Engl J Med 2005; 352; 2302-2313
5. Bear HD et al. . Breast Cancer Res Treat 2004; 88(suppl 1): S16. Abstract 26
6. Helman S. Natural history of small breast cancers. J Clin Oncol 1994; 12: 2229-2234.
7. Helman S, Weic H, Selbaum R. Oligometastases J Clin Oncol 1995; 13: 8-10.
8. Rossen PP, Groshen S, Kinne DW et al. Factors influencing prognosis in node-negative breast
carcinoma. Analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol
1993; 11: 2090-2100.
9. Donegan W.L. Tumor related prognostic factors for breast cancer. CA Cancer J Clin 1997; 47: 28-51.
10. Mc Guirewl, Clark GM. Prognostic factors and treatment decision in axillary node-negative breast
cancer patients. J Natl Cancer Inst 1992; 84: 1109-1114.
11. *** Trialists’ Collaborative Group. Tamoxifen for early breast cancer. An overview of the
randomized trials. Lancet 1998; 351: 145-1467.
12. Baum M, Buzdar A, Cuzick J et al. Anastrozole alone or in combination with tamoxifen versus
tamoxifen alone for adjuvant treatment of postmenopausal women with early stage breast cancer:
results of the ATAC(Arimidex, Tamoxifen alone or in combination) trial efficacy and safety update
analysis. Cancer 2003; 98: 1802-1810.
13. Thurlliman B, Keshaviah A, Coates S et al. A comparation of letrozole and tamoxifen in
postmenopausal women with early breast cancer. N Engl J Med 2005; 353: 2747-2757.
14. Coombes RC, Hall E, Gibson LJ et al. A randomized trial of exemestane after two to three years
of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 2004;
350: 1081-1092.
15. Schwartz R, Mc.Kenzie W, Alexander J et al. Congestive heart failure and left ventricular
dysfunction complicating doxorubicin therapy. A seven years experience using radionuclide
angiocardiography. Am J Med 1987; 82: 1109-1118.
16. von Hoff D, Layard M, Basa P et al. Risk factors for doxorubicin-induced congestive heart failure.
Ann Inter Med 1979; 91: 710-717.
17. Perou CM, Sorlie T, Eisen MB et al. Molecular portraits of human breast tumors. Nature 2000;
406: 747-752.
Published
2019-11-04