Multimodal treatment of primary breast carcinoma: analysis of accomplishments and problem areas

The management of primary breast carcinoma has undergone a successful change during the decade of the 1970s. Chemotherapy administered after mastectomy in patients with involved axillary nodes has not only prolonged disease-free survival in certain patient groups but has lengthened their over-all survival in comparison to patients treated with mastectomy alone. The concepts for use of chemotherapy after surgery, established in murine tumor models, have been extended to human subjects with breast cancer and proved of value. It remains to be determined which drug regimens have the best therapeutic index and which are most useful in specific subgroups of patients. Other breast carcinoma patients besides those with involved axillary nodes may also benefit from this surgery-plus-chemotherapy mode of treatment. We review the past, present and future clinical trials of chemotherapy after mastectomy and discuss the various aspects which bear on their successes and failures.