[Adjuvant chemotherapy in breast cancer: present status]

Abstract

Adjuvant chemotherapy should be conducted at present only under controlled conditions ("studies") with the consent of the patient after supplying her with adequate information ("informed consent"). The most important prognostic factor in primary carcinoma of the breast is the axillary lymph node status. The decisive role with regard to determining the further course of action and mapping out the treatment strategy will be played by the operating surgeon and the pathologists. Adjuvant chemotherapy can prolong the relapse-free survival time for all prognostic sub-groups known so far (the differences, however, are not significant in every case). It is very probable that the total survival rate will be improved for certain sub-groups. The effectivity of adjuvant chemotherapy decreases with increasing involvement of the lymph nodes. Pre-menopausal patients with one to three affected lymph nodes presently derive the biggest benefit from adjuvant chemotherapy. Short-term chemotherapy (up to 6 months) will suffice. The optimal treatment period is not yet known. The aggressivity of the adjuvant chemotherapy chosen for a particular case is of absolutely paramount importance. Provided the dosage is the same for both groups, there is no evidence of any clear difference between pre-menopausal and post-menopausal patients. It seems, however, that the quantitative reduction of the relapse rate is greater with pre-menopausal patients. Onset of chemotherapy should be as early as possible after surgery (14th postoperative day). A dosage schema should be followed according to calculated full dosage, if possible via the intravenous route of administration.(ABSTRACT TRUNCATED AT 250 WORDS)