[Adjuvant chemotherapy of breast cancer]

Numerous randomized trials have been conducted in an attempt to demonstrate the role of adjuvant chemotherapy in localized operable breast cancer. A major meta-analysis has demonstrated its effectiveness in certain indications. These trials show that only long-term combination chemotherapy has an undeniable efficacy. The reference protocol is the classical CMF combining cyclophosphamid, methotrexate and 5 fluoro-uracil. Efficacy is clear for patients under 50 years of age. After this age, tamoxifen is effective. There does not appear to be any benefit from prolonging chemotherapy over 6 months. The meta-analysis has not however answered all the questions raised by adjuvant chemotherapy. Should chemotherapy be used in N-forms? What is the effect of treatment in patients over 65? What is the optimal treatment duration? Is there a dose-efficacy relationship? What is the relative effect of chemotherapy versus radiotherapy? Does perioperative chemotherapy add any benefit? What should be the relative roles of hormone therapy and chemotherapy? Is castration as effective as chemotherapy before menopause and tamoxifen after menopause? Currently, only partial answers to these questions have been obtained and many remaining problems will only be solved by the results of controlled trials currently under way.