Adjuvant Systemic Therapy for Breast Cancer Patients Without Lymph Node Metastases (N-)
Several issues have recently been raised with respect to the treatment of patients diagnosed as having no axillary metastases after removal of breast cancer and axillary clearance. Patients with N- disease who were treated in the more recent controlled clinical trials have higher relapse rates than those entered in the earlier series from which our perception of prognosis for these patients has been derived. This could be due to a reporting bias, to a selection of patients for study who have a worse prognosis, or because the prognosis for N- breast cancer patients in general has in fact changed from what it was a decade or so ago.
A second important issue is the fact that major trials using either systemic endocrine therapy or chemotherapy have yielded significant improvement in terms of disease-free survival. Adjuvant therapy policies — particularly those affecting women who elect not to be treated within the framework of a clinical trial — are once again in a state of re-evaluation. This summary makes the point that women with N- breast cancer should be treated within clinical trials because the many factors which must be considered for therapy decision-making can most efficaciously be assessed within such a framework.
KeywordsToxicity Estrogen Oncol Methotrexate Tamoxifen
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