• Patients with lesions in the extreme edge of the breast may be better candidates for this option, since if a
mastectomy were done, it might require removing additional portions of the chest wall.
• A small percentage of patients will develop a recurrence in the breast area following limited surgery to
conserve the breast. Mastectomy may still be able to control the disease in most cases.
• Radiotherapy should not be given during pregnancy because of the hazard to the fetus.
Adjuvant Chemotherapy and Hormone Therapy After surgical treatment to control local disease in the breast, adjuvant chemotherapy is recommended to reduce the risk of recurrence.
• Drug combinations shown to produce a survival advantage include CMF (Cytoxan + methotrexate +
5-fluorouracil [5-FU]) with or without VP (vincristine + prednisone), and CAF (Cytoxan + Adriamycin +
5-FU).
• Earlier combinations that have been tried include L-PAM (Alkeran) + 5-FU for premenopausal women and
L-PAM + 5-FU + tamoxifen for postmenopausal women with receptor positive tumors. Recent studies
suggest that shorter courses of Cytoxan + Adriamycin (AC) may be at least as good as CMF given for six
months.
• Adriamycin (doxorubicin) can produce cardiac toxicity, a form of heart muscle weakness. This can be disabling
and life-threatening, but the risk can be reduced by giving the drug slowly via continuous intravenous infusion
over one or more days and by limiting the total dosage.
