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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effect of systemic adjuvant treatment on first sites of breast cancer relapse
The Lancet, Volume 343, No. 8894, Year 1994
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Description
Summary. Adjuvant systemic treatment for resectable breast cancer changes the natural history of the disease but provides only a small and delayed effect on survival. Evaluation of the types of first relapse avoided by available treatments may explain why effects on mortality are small and appear late during follow-up. In randomised clinical trials done by the International Breast Cancer Study Group (IBCSG) between 1978 and 1985, 2108 patients with node-positive disease received more-effective treatments (6 or more cycles of cyclophosphamide, methotrexate, fluorouracil and prednisone; with or without tamoxifen, or tamoxifen and prednisone alone), and 722 patients received less-effective treatments (no treatment or a single cycle of chemotherapy). 3 main categories of first site of relapse were defined and evaluated by cumulative incidence analysis: local or regional, and distant soft tissue, bone, and viscera. The more-effective treatments reduced the cumulative incidence of first relapse in local or regional and distant soft tissue sites at 10 years from 36% to 18% (p=0·0001); first relapse in bone and viscera was not altered by the more-effective treatments. These results were similar for premenopausal and postmenopausal women, and for patients with oestrogen-receptor-positive or oestrogen-receptor-negative tumours. Adjuvant systemic treatments in current use improve patient outcome mainly by reducing the incidence of first local or regional and distant soft-tissue relapses, while first recurrences in bone or viscera are influenced much less. More intensive treatments at present being tested in clinical trials might affect bone and visceral relapses and have a greater and earlier influence on survival. © 1994.
Authors & Co-Authors
Goldhirsch, Aaron
Switzerland, Lugano
Ospedale Civico, Lugano
Gelber, Richard D.
United States, Boston
International Breast Cancer Study Group Statistical Center
Price, Karen N.
United States, Boston
International Breast Cancer Study Group Statistical Center
Castiglione, Monica M.
Switzerland, Bern
Ibcsg Coordinating Center
Coates, Alan S.
Australia, Sydney
Royal Prince Alfred Hospital
Rudenstam, Carl Magnus
Sweden
Sahigren's Hospital
Collins, John Paxton
Australia, East Melbourne
Cancer Council Victoria
Lindtner, Jurij
Slovenia, Ljubljana
Onkološki Inštitut Ljubljana
Hacking, Anne
South Africa, Observatory
Groote Schuur Hospital
Marini, Giovanni
Italy, Brescia
Spedali Civili Di Brescia
Byrne, Michael J.J.
Australia, Perth
Sir Charles Galrdner Hospital
Cortés-Funés, Hernán
Spain, Madrid
Madrid Breast Cancer Group
Schnürch, G.
Germany, Dusseldorf
Heinrich-heine-universität Düsseldorf
Brunner, Kurt W.
Switzerland, Bern
University Hospital Bern
Tattersall, Martin H.N.
Australia, Sydney
Royal Prince Alfred Hospital
Forbes, John Frederick
Australia, Waratah
Newcastle Mater Misericordiae Hospital
Senn, Hansjörg
Switzerland, St Gallen
Kantonsspital St.gallen
Statistics
Citations: 83
Authors: 17
Affiliations: 15
Identifiers
Doi:
10.1016/S0140-6736(94)91221-1
ISSN:
01406736
Research Areas
Cancer
Health System And Policy
Study Design
Cohort Study
Participants Gender
Female