One hundred women with primary breast cancer with 4 or more metastatic axillary nodes were treated for 9 months postoperatively with vincristine, prednisone, cyclophosphamide, methotrexate, and fluorouracil (VPCMF).
Sixty-five women have been observed for a minimum of 5 years or until failure and the rest for 3 years or more. For 73 women who received adjuvant chemotherapy only, observed for 5% years median, disease-free status by life table analysis is 68% at 8 years. No significant difference was found between response of pre-and postmenopausal women in disease-free interval or survival. Mortality compared to expectation was sharply reduced; only 9 of 73 have died. These findings demonstrate the long term effectiveness of relatively short-term surgical adjuvant combination chemotherapy in pre-and postmenopausal patients with breast cancer at righ risk.
Cancer 44:793-798, 1979. URGERY ALONE IS NOT an adequate life-S saving procedure in women with breast cancer who demonstrate axillary metastases. Although 76% of women without axillary metastases are still disease-free at ten years, this figure drops to 35% for those with 1,2, or 3 nodes involved with metastases, and to 14% for those with 4 or more nodes i n v o l ~e d . ~ Death inexorably follows clinically evident metastatic disease. Surgical adjuvant chemotherapy trials have ordinarily been based on treatments shown to have activity in metastatic breast cancer. Early trials used thioTEPA and were geared to kill tumor cells spread during the surgical procedure; treatment was limited to the first 72 hours po~toperative1y.l~ Recent studies have utilized repeated pulses of chemotherapy during 12 or 24 months postoperatively in From the Buffalo General Hospital,