Post-mastectomy radiotherapy benefits subgroups of breast cancer patients with T1-2 tumor and 1-3 axillary lymph node(s) metastasis.

BACKGROUND: To determine the role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-2 and N1 disease. PATIENTS AND METHODS: A total of 207 postmastectomy women were enrolled. The 5-year Kaplan-Meier estimates of locoregional recurrence rate (LRR), distant recurrence rate (DRR) and overall survival (OS) were analyzed by different tumor characteristics. Multivariate analyses were performed using Cox proportional hazards modeling. RESULTS: With median follow-up 59.5 months, the 5-year LRR, DRR and OS were 9.1%, 20.3% and 84.4%, respectively. On univariate analysis, age < 40 years old (p = 0.003) and Her-2/neu over-expression (p = 0.016) were associated with higher LRR, whereas presence of LVI significantly predicted higher DRR (p = 0.026). Negative estrogen status (p = 0.033), Her-2/neu overexpression (p = 0.001) and LVI (p = 0.01) were significantly correlated with worse OS. PMRT didn't prove to reduce 5-year LRR (p = 0.107), as well as 5-year OS (p = 0.918). In subgroup analysis, PMRT showed significant benefits of improvement LRR and OS in patients with positive LVI. CONCLUSIONS: For patients with T1-2 and N1 stage breast cancer, PMRT can decrease locoregional recurrence and increase overall survival only in patients with lymphovascular invasion.

Weekly paclitaxel combining with gemcitabine is an effective and safe treatment for advanced breast cancer patients.

OBJECTIVE: Patients with metastatic breast cancer usually accept several lines of chemotherapy. This retrospective study is to analyze the therapeutic effect and tolerance of weekly paclitaxel/gemcitabine combination on patients with metastatic breast cancer. METHODS: Paclitaxel 80 mg/m(2) and gemcitabine 800 mg/m(2) were administered sequentially on days 1, 8 and 15 every 28 days. Patients with measurable metastatic breast cancer or locally advanced breast cancer were included. RESULTS: From March 2005 to December 2006, 50 patients received this treatment at Chang Gung Memorial Hospital, Kaohsiung Medical Center. Thirteen (26%) patients accepted this regimen as their first-line treatment for metastatic breast cancer and 25 (50%) patients accepted this regimen after at least three lines of therapies for metastatic breast cancer. The overall response rate was 56% (95% confidence interval: 42.2-69.8%), 2 patients achieved complete response and 26 patients (52, 95% confidence interval: 38.2-65.9%) achieved partial response. The median progression free survival was 7.4 months (95% confidence interval: 5.5-9.3 months), and the median overall survival was 19.0 months (95% confidence interval: 9.7-28.3 months). Except alopecia, the most common Grade 3/4 toxicities were anemia and leucopenia; the incidences of both were fewer than 10%. CONCLUSIONS: The combination of weekly gemcitabine and paclitaxel in patients with advanced breast cancer showed acceptable outcome and excellent toxic profiles. This therapeutic benefit could be achieved in any linage of patients with good performance status; earlier usage of this regimen can provide better result.

High expression of endoglin in primary breast cancer may predict response to neoadjuvant chemotherapy.

Neoadjuvant chemotherapy (NAC) is a widely­used treatment for breast cancer, as it may render unresecta-ble breast tumors to become resectable. In addition, NAC provides the unique opportunity to assess response to treatments within months rather than years of follow­up. However, predictive markers of tumor response to NAC are lacking. Therefore, the present study aimed to investigate the expression of endoglin, a marker of angiogenesis, and its association with pathologic responses to NAC. Samples from 34 breast cancer patients were obtained prior to and following NAC treatment. Immunohistochemical staining for endoglin and the mechanistic target of rapamycin (mTOR) was performed, and the correlation between the expression of these markers and pathologic response was examined. The overall response rate to NAC of these 34 patients was 67.6%. A mean microvascular density value of 14 served as a threshold score for the increased expression of endoglin. Increased expression of endoglin in primary tumors prior to NAC correlated with improved response in primary tumors (P=0.019) or in primary tumors and regional lymph nodes (P=0.014), when compared with reduced expression of endoglin. Increased expression of mTOR following NAC was additionally correlated with improved response to NAC. The results of the present study demonstrated that the expression of endoglin in breast tumor samples prior to NAC may be a predictor of treatment response. Long­term follow­up of clinical outcome is required to explain the elevation of mTOR expression levels following NAC treatment in responsive tumors.