Histological evaluation of the effects of intraarterial chemotherapy for advanced breast cancer: a long-term followup study with respect to the survival rate

Preoperative transcatheter arterial infusion chemotherapy for locally advanced breast cancer (stage IIIb) for down-staging and increase of resectability

OBJECTIVES

To evaluate the clinical usefulness of preoperative transcatheter arterial infusion chemotherapy (TAIC) for locally advanced breast cancer.

METHODS

Seven patients with unresectable locally advanced breast cancer (stage IIIb) underwent TAIC percutaneously 1-3 times (mean, 1.7 times) until tumors became resectable. Anticancer drugs were injected into both the internal mammary and the distal subclavian arteries.

RESULTS

There was no major complication related to the procedure. The mean tumor size was significantly decreased from 10.0+/-3.9 to 5.1+/-2.5 cm (P=0.0086). Skin and muscle invasions were improved in two patients (28%) and lymph nodes disappeared in one patient (14%). In two patients (28%), down-staging was achieved from stage IIIb to stage IIIa. All tumors turned into resectable, and mastectomy was performed with a mean period of 35 days (range 9-60 days) after TAIC. Marked decrease in tumor size allowed one patient to receive breast-conserving surgery. There was no local recurrence in any patient. However, five patients (71%) experienced distant metastases. The 3-year disease free and overall survival were 0 and 71.4%, respectively.

CONCLUSIONS

TAIC for locally advanced breast cancer is useful in reducing tumor size and achieving down-staging in a relatively short period, leading to an expanded surgical indication.

Intraarterial infusion chemotherapy and radiotherapy with or without surgery for patients with locally advanced or recurrent breast cancer

We analyzed response, side effects, and local control rates of a multimodal treatment consisting of intraarterial infusion chemotherapy (IAIC) and radiotherapy with or without surgery for patients with locally advanced or recurred breast cancer. Thirty-three patients, clinically diagnosed as stage IIB in 1, IIIA in 2, IIIB in 12, IV in 18, were treated from 1991 to 1998. Twenty-five were primary and eight were recurrent cases after surgery. IAIC started as initial treatment up to three times maximum. In most cases, doxorubicin 50 mg, cisplatin 50 mg, and mitomycin 10 mg were infused in the subclavian and/or internal mammary artery. After IAIC, patients in primary cases underwent radical mastectomy or breast conservation surgery, after radiotherapy at a total dose of 50 Gy/25 fractions/5 weeks with a boost of 10 Gy. In recurrent cases, a full dose of radiotherapy was delivered. Clinical objective and complete response rates were 78% and 9% after IAIC. Despite a high rate of residual positive margin (67%) or clinically residual carcinoma, local recurrence developed only in 2 patients (6%) and local control rates at 5 years were calculated as 89%. Bone marrow suppression was frequent, and skin vesiculation (15%) and ulceration (9%) were experienced after IAIC. Skin ulcer (6%), brachial plexus neuropathy (3%), and radiation pneumonitis (3%) occurred as late toxicity. IAIC was effective as an induction treatment and radiotherapy played a role of local control for patients with locally advanced or recurrent breast cancer.