Adjuvant Therapy of Primary Breast Cancer

The ultimate "consumer" of the data presented at conferences on the primary treatment of operable breast cancer is the patient, and when, as in this disease, the benefits of therapy are relatively mod­ est, the availability and interpretation of the data from trials be­ comes an issue of primary importance. The effects of present treat­ ment are in fact such that more patients relapse despite therapy than are estimated to benefit from it. It is, therefore, extremely dif­ ficult for the physician to recommend unequivocally one particular adjuvant treatment modality for the vast population of women with breast cancer. The interpretation of results from clinical research-oriented pro­ grams is constantly applied, however, in the treatment of breast cancer patients outside of clinical trials. From presented or publish­ ed data, many physicians extrapolate indications for the use of a given treatment regimen for their patients, perceiving it as the "best available therapy. " It is essential that the "best available therapy" be selected individually for each patient. However, considering the modest effect of treatment upon outcome, it is imperative that those who provide the data - those who are involved in both pa­ tient care and clinical research - make it known that the best cur­ rent treatment for the population of breast cancer patients is avail­ able within the framework of clinical trials. In this way not only present-day patients but also future ones will derive the greatest benefit.

Inhalt

Biological Mechanisms and Models for New Approaches to Adjuvant Therapy of Breast Cancer.- Patterns of Treatment Failure - Implications for New Treatment Approaches.- New Information on Drug Resistance: Implications for the Adjuvant Treatment of Breast Cancer.- Correlation of Dose Intensity and Prognosis in Adjuvant Chemotherapy: An Extended Controversy.- Dose Response for Adjuvant Chemotherapy of Breast Cancer: Experimental and Clinical Considerations.- Neoadjuvant (Pre- and Perioperative) Therapy.- Experimental Basis and Clinical Reality of Preoperative (Neoadjuvant) Chemotherapy in Breast Cancer.- Neoadjuvant Chemotherapy in the Conservative Management of Breast Cancer: A Study of 252 Patients.- Randomized Perioperative Therapy in Operable Breast Cancer: The Ludwig Trial V.- Is There a Role for Perioperative Adjuvant Cytotoxic Therapy in the Treatment of Early Breast Cancer?.- Problems of Rational Follow-up and Salvage Therapy.- Radiation Therapy in Prevention and Salvage of Local Relapse: Its Prognostic Implication.- Salvage Treatments in Relapsing Resectable Breast Cancer.- Time Course and Prognosis of Mammary Failure Following Breast-Conserving Therapy.- Detection of Recurrence: A Critical Assessment of Existing Methods and Programs.- Factors Associated with Local Recurrence as a First Site of Failure Following the Conservative Treatment of Early Breast Cancer.- Critical Review of Problems of Rational Follow-up and Salvage Therapy.- Adjuvant Therapy in Premenopausal Patients.- Endocrine Effects of Adjuvant Chemotherapy in Premenopausal Women: Suggestions for the Future.- The Milan Experience with Adjuvant Chemotherapy in Premenopausal Breast Cancer.- Adjuvant Chemo- and Endocrine Therapy Alone or in Combination in Premenopausal Patients (GABG Trial 1).- Scottish Adjuvant Breast Cancer Trials: Results in Pre-menopausal Patients.- Critical Review of Adjuvant Therapy in Premenopausal Patients.- Adjuvant Therapy in Postmenopausal Patients.- The Role of Adjuvant Endocrine Therapy in Primary Breast Cancer.- How to Improve Adjuvant Treatment Results in Postmenopausal Patients.- Adjuvant Chemo-Endocrine Therapy or Endocrine Therapy Alone for Postmenopausal Patients: Ludwig Studies III and IV.- Chemo- or Endocrine Adjuvant Therapy Alone or Combined in Postmenopausal Patients (GABG Trial 1).- Prognostic Factors and Treatment for Node-Negative Patients.- Prognosis in Breast Cancer.- Adjuvant Chemotherapy for Node-Negative Breast Cancer Patients.- Significant Survival Benefit of Node-Negative Breast Cancer Patients Treated with Adjuvant Chemotherapy: Seven-year Results.- Adjuvant Immunotherapy in Node-Negative Patients: Results of a Scandinavian Study.- Breast-Conserving Surgery and Adjuvant Radiotherapy.- Breast-Conserving Surgery and the Role of Adjuvant Radiotherapy: A Review.- New Trends in Breast Cancer Surgery.- Therapy of Early Breast Cancer: Preliminary Results of the German Breast Cancer Study.- Methodology of Adjuvant Trials and Interpretation of Results.- Methods for Assessing Treatment Efficacy in Trials for Adjuvant Therapy for Breast Cancer.- Overview of Adjuvant Radiotherapy for Breast Cancer.- Randomized Multicenter 2 × 2-Factorial Design Study of Chemo/Endocrine Therapy in Operable, Node-Positive Breast Cancer (Protocol 2).- Critical Review: Methodology of Adjuvant Trials and Interpretation of Results.- Quality of Life: Psychological Aspects of Adjuvant Therapy of Breast Cancer.- Adjuvant Therapies in Breast Cancer and Quality of Life: A Critical Review of the TWiST Concept.- Rehabilitation of Patients with Primary Breast Cancer: Assessing the Impact of Adjuvant Therapy.- Coping and Survival in Patients with Primary Breast Cancer: A Critical Analysis of Current Research Strategies and Proposal of a New Approach Integrating Biomedical, Psychological, and Social Variables.- Behavioral Side Effects of Adjuvant Chemotherapy.- Critical Review of Quality of Life: Psychosocial Aspects of Adjuvant Therapy in Breast Cancer.- Closing Summary and Outlook.