This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thames, H. D. Articles by Smith, C. D. Search for Related Content PubMed PubMed Citation Articles by Thames, H. D. Articles by Smith, C. D. Social Bookmarking                            What's this?

Frequency of First Metastatic Events in Breast Cancer: Implications for Sequencing of Systemic and Local-Regional Treatment

From the Departments of Biomathematics and Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Address reprint requests to Howard D. Thames, Department of Biomathematics, Box 237, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030; email hdt{at}odin.mdacc.tmc.edu

PURPOSE: The sequencing of treatment for early breast cancer is controversial. The purpose of this study was to quantify the risk of delaying surgery, using estimates of the frequency of first metastases from breast primary tumors.

PATIENTS AND METHODS: The probability that 560 (node-negative), 657 (with one to three positive nodes), and 505 (with more than three positive nodes) women treated without adjuvant chemotherapy would be free of distant disease at presentation was fit to a mathematical model of the seeding of distant metastases and combined with estimates of the growth rate to calculate the frequency of first distant disseminations per month.

RESULTS: Frequencies of first distant metastases were approximately 1% to 2% per month, 2% to 4% per month, and 3% to 6% per month in T1 patients who were node-negative, had one to three positive nodes, or more than three positive nodes, respectively. As a result, the typical patient with T1 disease, who has a 70% to 80% chance of being free of distant disease, runs a 1% to 4% risk of distant dissemination for each month surgery is delayed. Assuming a 30% reduction in mortality caused by adjuvant chemotherapy, the model predicts that T1 patients treated with neoadjuvant chemotherapy would potentially have a higher rate of distant metastasis development than those treated with an initial surgical resection followed by adjuvant chemotherapy.

CONCLUSION: We formulate the hypothesis that optimal sequencing of surgery and systemic treatment of breast cancer may be size-dependent, with a disadvantage or no benefit from neoadjuvant treatment for T1 patients but an increasing benefit with increasing size of the primary tumor.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C Natoli, E Cianchetti, N Tinari, D Angelucci, A Grassadonia, M Zilli, C Ficorella, E Ricevuto, S Grossi, M De Tursi, et al. A phase II study of dose-dense epirubicin plus cyclophosphamide followed by docetaxel plus capecitabine and pegfilgrastim support as preoperative therapy for patients with stage II, IIIA breast cancer Ann. Onc., June 1, 2007; 18(6): 1015 - 1020. [Abstract] [Full Text] [PDF]

				G. Ganem, M. Tubiana-Hulin, P. Fumoleau, M. Combe, J.-L. Misset, J.-M. Vannetzel, T. Bachelot, L. R. De Ybarlucea, V. Lotz, B. Bendahmane, et al. Phase II trial combining docetaxel and doxorubicin as neoadjuvant chemotherapy in patients with operable breast cancer Ann. Onc., November 1, 2003; 14(11): 1623 - 1628. [Abstract] [Full Text] [PDF]

				R. Rouzier, J.-M. Extra, J. Klijanienko, M.-C. Falcou, B. Asselain, A. Vincent-Salomon, P. Vielh, and E. Bourstyn Incidence and Prognostic Significance of Complete Axillary Downstaging After Primary Chemotherapy in Breast Cancer Patients With T1 to T3 Tumors and Cytologically Proven Axillary Metastatic Lymph Nodes J. Clin. Oncol., March 1, 2002; 20(5): 1304 - 1310. [Abstract] [Full Text] [PDF]