Adjuvant Therapy of Primary Breast Cancer

1. Front Matter

   Pages I-XVI

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2. Biological Mechanisms and Models for New Approaches to Adjuvant Therapy of Breast Cancer

   1. Patterns of Treatment Failure — Implications for New Treatment Approaches

      • M. H. N. Tattersall

      Pages 1-7

   2. New Information on Drug Resistance: Implications for the Adjuvant Treatment of Breast Cancer

      • J. H. Goldie

      Pages 8-16

   3. Correlation of Dose Intensity and Prognosis in Adjuvant Chemotherapy: An Extended Controversy

      • W. M. Hryniuk

      Pages 17-24

   4. Dose Response for Adjuvant Chemotherapy of Breast Cancer: Experimental and Clinical Considerations

      • E. Frei III

      Pages 25-27

3. Neoadjuvant (Pre- and Perioperative) Therapy

   1. Experimental Basis and Clinical Reality of Preoperative (Neoadjuvant) Chemotherapy in Breast Cancer

      • J. Ragaz, J. H. Goldie, R. Baird, P. Rebbeck, V. Basco, A. Coldman

      Pages 28-35

   2. Neoadjuvant Chemotherapy in the Conservative Management of Breast Cancer: A Study of 252 Patients

      • C. Jacquillat, M. Weil, G. Auclerc, M.-F. Auclerc, D. Khayat, F. Baillet

      Pages 36-42

   3. Randomized Perioperative Therapy in Operable Breast Cancer: The Ludwig Trial V

      • A. Goldhirsch, R. D. Gelber

      Pages 43-53

   4. Is There a Role for Perioperative Adjuvant Cytotoxic Therapy in the Treatment of Early Breast Cancer?

      • J. Houghton, M. Baum, R. Nissen-Meyer, D. Riley, R. A. Hern

      Pages 54-61

4. Problems of Rational Follow-up and Salvage Therapy

   1. Radiation Therapy in Prevention and Salvage of Local Relapse: Its Prognostic Implication

      • R. Hünig, J. M. Kurtz

      Pages 62-68

   2. Salvage Treatments in Relapsing Resectable Breast Cancer

      • P. Valagussa, C. Brambilla, M. Zambetti, G. Bonadonna

      Pages 69-76

   3. Time Course and Prognosis of Mammary Failure Following Breast-Conserving Therapy

      • J. M. Kurtz, J.-M. Spitalier, R. Amalric, H. Brandone, Y. Ayme, C. Bressac et al.

      Pages 77-82

   4. Detection of Recurrence: A Critical Assessment of Existing Methods and Programs

      • W. F. Jungi, A. I. Streit, L. Schmid, H.-J. Senn

      Pages 83-91

   5. Factors Associated with Local Recurrence as a First Site of Failure Following the Conservative Treatment of Early Breast Cancer

      • J. Boyages, A. Recht, J. Connolly, S. Schnitt, M. A. Rose, B. Silver et al.

      Pages 92-102

   6. Critical Review of Problems of Rational Follow-up and Salvage Therapy

      • D. C. Tormey

      Pages 103-105

5. Adjuvant Therapy in Premenopausal Patients

   1. Endocrine Effects of Adjuvant Chemotherapy in Premenopausal Women: Suggestions for the Future

      • D. C. Tormey

      Pages 106-112

   2. The Milan Experience with Adjuvant Chemotherapy in Premenopausal Breast Cancer

      • G. Bonadonna, P. Valagussa, M. Zambetti, C. Brambilla

      Pages 113-117

   3. Adjuvant Chemo- and Endocrine Therapy Alone or in Combination in Premenopausal Patients (GABG Trial 1)

      • M. Kaufmann, W. Jonat, U. Abel

      Pages 118-125

   4. Scottish Adjuvant Breast Cancer Trials: Results in Pre-menopausal Patients

      • H. J. Stewart

      Pages 126-131

   5. Critical Review of Adjuvant Therapy in Premenopausal Patients

      • H. T. Mouridsen

      Pages 132-135

The ultimate "consumer" of the data presented at conferences on the primary treatment of operable breast cancer is the patient, and when, as in this disease, the benefits of therapy are relatively mod­ est, the availability and interpretation of the data from trials be­ comes an issue of primary importance. The effects of present treat­ ment are in fact such that more patients relapse despite therapy than are estimated to benefit from it. It is, therefore, extremely dif­ ficult for the physician to recommend unequivocally one particular adjuvant treatment modality for the vast population of women with breast cancer. The interpretation of results from clinical research-oriented pro­ grams is constantly applied, however, in the treatment of breast cancer patients outside of clinical trials. From presented or publish­ ed data, many physicians extrapolate indications for the use of a given treatment regimen for their patients, perceiving it as the "best available therapy. " It is essential that the "best available therapy" be selected individually for each patient. However, considering the modest effect of treatment upon outcome, it is imperative that those who provide the data - those who are involved in both pa­ tient care and clinical research - make it known that the best cur­ rent treatment for the population of breast cancer patients is avail­ able within the framework of clinical trials. In this way not only present-day patients but also future ones will derive the greatest benefit.

• adjuvant therapy
• breast cancer
• cancer
• clinical trial
• mortality
• oncology
• radiotherapy
• Radiaton Oncology

• Medizinische Klinik C, Kantonsspital, St. Gallen, Switzerland

  Hans-Jörg Senn

• Servizio Oncologico Cantonale, Ospedale Civico, Lugano, Switzerland

  Aron Goldhirsch

• Division of Biostatistics and Epidemiology, Dana-Farber Cancer Institute, Boston, USA

  Richard D. Gelber

• Abteilung für Hämatologie und Onkologie Medizinische Klinik C, Kantonsspital, St. Gallen, Switzerland

  Bruno Osterwalder

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