Conservation treatment intensified with an anti-estrogen agent and CAF chemotherapy for stage I and II breast cancer.

In order to improve both cosmetic results and survival rates, we performed breast-conservation treatment (BCT) intensified with tamoxifen and CAF chemotherapy to 218 out of 224 patients who visited our department with the desire of breast-conservation between August 1989 to December 1998. Of these patients, 68 presented with tumors of stage I, and another 122 stage II. All patients were administered tamoxifen (for pre-menopausal women) or tremifene (for post-menopausal women) orally: tamoxifen and tremifene administration was started just after confirmation of the breast cancer based on the findings of fine-needle aspiration cytology. All patients underwent lumpectomy with or without axillary dissection (level I and II). For patients with T2 tumors, the lumpectomy was performed following two to four times of CAF chemotherapy. Following conservative surgery, patients were treated with radiation therapy to the intact breast and ipsilateral axilla to a total dose of 4400 cGy with a conedown to a total median dose of 5300 cGy. At the end of March 1999, the mean follow-up time was 49.0 months. In spite of high-positivity (approximately 30%) of microscopically surgical margin, local recurrence rate is considerably low, and only 2 patients experienced local recurrence. Cause-specific survival rate for patients of stage I is 100%, and that of stage II is 91.7% at 5 years. The cosmetic results of therapy were also considered good.