Abstract
Between 1977 and 1993, 384 breast cancer patients were followed up post-operatively every 4 or 6 months with a serum tumour marker panel (CEA-TPA-CA15-3) and the usual imaging techniques. Twenty-eight patients were treated 13.5 +/- 10 months (mean +/- s.d.) before the clinical and/or radiological occurrence of distant metastases that were suspected because of an increase in the tumour markers (patients treated 'early'). Their outcome was compared with that of 22 similar patients who were treated only after a definite radiological diagnosis was achieved (patients treated 'not early'). The median survivals from mastectomy and salvage treatment were also compared for the two groups. The groups were similar for all the major prognostic factors (menopause, staging, hormone dependency). In the group treated 'early', the lead time from the tumour marker increase to the clinical and radiological signs of metastases was significantly longer than that of the group not treated 'early' (13.5 +/- 10 vs 3.4 +/- 2.8 months respectively; P < 0.001 by unpaired t-test). For patients treated 'early', the survival curves up to 30 months after salvage treatment and up to 72 months after mastectomy showed greater survival than those for the patients treated later (42.9% vs 13.6% and 42.9% vs 22.7% respectively; P = 0.04 in both instances). These data suggest that treatment triggered by rising tumour markers before clinical and/or radiological appearance of distant metastases can be useful in prolonging both the asymptomatic interval and the duration of response of some relapsed patients. Randomized prospective trials must be encouraged to confirm these data and to better evaluate the effect on the disease-free survival (DFS) and overall survival (OS) of 'early' salvage treatment protocols.
Highlights
As we have previously reported, post-operative monitoring with the CEA-TPA-Cal5-3 association showed 87% sensitivity for the early diagnosis of distant metastases
The aim of this study was to compare the lead time from tumour marker increase to the clinical and radiological signs of metastases and survivals from mastectomy and salvage treatment in patients treated 'early', i.e. at a time of elevated tumour markers and negative radiological clinical findings, and in patients treated conventionally at the time of positive radiological and/or clinical findings
Disease recurrences occurred in 65 patients; 13 of these patients belonged to the group of 79 patients who withdrew from the follow-up protocol and two others were excluded as a result of rapidly progressive disease
Summary
The aim of this study was to compare the lead time from tumour marker increase to the clinical and radiological signs of metastases and survivals from mastectomy and salvage treatment in patients treated 'early', i.e. at a time of elevated tumour markers and negative radiological clinical findings, and in patients treated conventionally at the time of positive radiological and/or clinical findings
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