Mastectomy as an Adjuvant to Chemotherapy for Locally Advanced or Metastatic Breast Cancer

• Patients with unresectable tumors require local treatment of ulcerating or fungating masses. Chemotherapy can shrink the tumor, permitting mastectomy. Continued chemotherapy treats the overt or micrometastases. Of 27 patients with bulky primary tumors, 15 had overt metastases and 12 did not. Thirteen of the 27 had inflammatory carcinoma. After three to four chemotherapy courses, 24 patients were operable, and 22 underwent mastectomy. Eighteen of the 22 had closure without skin grafts. In three, disease recurred at the primary site, and in five at both primary and distal sites. Preoperatively, one patient (4%) achieved complete response and 19 (70%) achieved partial response. After mastectomy, five patients with metastases in stable partial response further responded to chemotherapy and achieved complete response. Chemotherapy with adjuvant mastectomy is technically feasible and offers the possibility of improved duration of survival in some patients.

(Arch Surg 1982;117:882-887)