Systemic therapy in patients with node-negative breast cancer: a commentary based on two national surgical adjuvant breast and bowel project (NSABP) clinical trials

Article Abstract:

Two clinical trials studying patients with node-negative breast cancer were performed by the National Surgical Adjuvant Breast and Bowel Project. Prognosis was evaluated for women who had systemic therapy (chemotherapy) as a follow-up to initial surgery for primary operable breast cancers where no additional cancer was detected in adjacent node areas. They were compared with similar patients who received no follow-up treatment. The first trial consisted of 731 women with estrogen-receptor-negative tumor types (tumors that do not react to estrogen). These patients were subdivided; one group was treated with a sequential chemotherapy program and the other group was given no therapy. The second trial consisted of 2,834 women that had been diagnosed with estrogen-receptor-positive tumors (tumors that react and thrive in the presence of estrogen). This group was similarly subdivided; approximately half received follow-up chemotherapy and the other half did not. All subjects were monitored for four years and the percentage of women who survived without disease was evaluated. The disease-free survival rates of women who had estrogen-receptor-negative tumors was 71 percent; disease-free survival rates for those who had estrogen-receptor-positive tumors was 77 percent. Because of the similarity of the survival rates in the two groups, it was concluded that no significant differences in mortality or overall prognosis occurred due to tumor type. The progress of those individuals who received the systemic treatment did not suggest that any specific type of therapy was better than the others. It was noted that the relatively short follow-up period of four years was not sufficient to fully assess the overall survival rates and the possible benefits that were derived from the treatments. However, it was concluded that the overall survival rates of all women in both trials were low enough to justify using chemotherapy as a follow-up to surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Comparative analysis, Adjuvant chemotherapy

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Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer

Article Abstract:

Lumpectomy, the surgical removal of a tumor from the breast, followed by radiation therapy, was conducted in 1,843 patients suffering from Stage I or II breast cancer. Chemotherapy was used as well in those women with cancer surrounding the nodes near the breast. Lumpectomy followed by radiation therapy resulted in a five-year survival rate of 85 percent, whereas the five-year survival rate of total mastectomy was 76 percent. At follow-up, eight years after initial treatments, 90 percent of the women who underwent lumpectomy followed by irradiation were free of tumors in the same breast, while only 61 percent of patients who did not receive radiation treatment remained tumor-free. In addition, 94 percent of the patients with lymph node involvement who were treated with a combination of lumpectomy, radiation, and chemotherapy had no recurrences in the breast treated. The value of radiation therapy in reducing the recurrence of tumors following lumpectomy continues to be significant. Furthermore, the data to date continue to support breast conservation (as contrasted with total mastectomy) for patients with primary breast cancer (cancer which has not moved to other sites in the body).

Care and treatment, Analysis, Cancer treatment, Radiotherapy, Lymph nodes, Mastectomy, Lumpectomy

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A randomized clinical trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen-receptor-negative tumors

Article Abstract:

Methotrexate and fluorouracil were administered to women following removal of breast tumors as a means of preventing recurrence of cancer in patients whose tumor cells did not have estrogen receptors and whose cancer had not spread to lymph nodes. Research findings indicate that these chemotherapeutic agents prolong disease-free survival in all patients who receive them with moderate and easily controlled toxic side-effects. It was necessary for the breast tumors to be large enough so that the estrogen-receptor concentration could be measured by conventional methods. Further trials should be conducted in order to assess potentially more effective therapeutic regimens using these drugs.

Methotrexate, Fluorouracil

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