Multimodal treatment of locoregionally advanced breast cancer

Fifty‐two patients with locally advanced primary breast cancer (T3, T4/N2, N3) without distant metastases were treated with three cycles of combination chemotherapy consisting of 5‐FU, Adriamycin and cyclophosphamide (FAC) and immunotherapy with Bacillus Calmette‐Guerin (BCG) followed by local therapy (simple mastectomy and/or radiotherapy to breast/chest wall and regional lymphatics) and adjuvant chemotherapy to complete two years of treatment. Forty‐nine of 52 (94%) patients were rendered free of clinically detectable disease. The median disease‐free interval was 24 months. At a median follow‐up time of 60 months, 40% of patients remained free of disease, off all therapy. Those patients who completed two years of therapy and started adjuvant chemotherapy promptly after local treatment had a 48% disease‐free survival at five years. Local recurrences were observed in 21% of patients. Distant metastases developed in 40% of patients. Despite good tolerance, treatment compliance was poor. The complete remission rate with this multimodal approach is high and long‐term disease‐free survival is achieved in a considerable number of patients.