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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPatients who develop isolated local or regional recurrences (ILRR) of breast cancer have a high risk of distant metastasis and death. The Adjuvant Chemotherapy in Treating Women Who Have Undergone Resection for Relapsed Breast Cancer (Chemotherapy as Adjuvant for Locally Recurrent Breast Cancer) [CALOR; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00074152\u0026amp;atom=%2Fspmdc%2F12%2F20%2F14.2.atom\u0022\u003ENCT00074152\u003C\/a\u003E] trial investigated the impact of chemotherapy on disease-free survival and overall survival in patients with ILRR.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAdjuvant\/Neoadjuvant Therapy\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPatients who develop isolated local or regional recurrences (ILRR) of breast cancer have a high risk of distant metastasis and death. The only prospective randomized trial of adjuvant chemotherapy in patients with ILRR reported at \u0026gt;11 years follow-up that patients treated with tamoxifen versus observation had significantly improved disease-free survival (DFS) but no overall survival (OS) advantage [Waeber M et al. \u003Cem\u003EAnn Oncol\u003C\/em\u003E 2003]. The Adjuvant Chemotherapy in Treating Women Who Have Undergone Resection for Relapsed Breast Cancer (Chemotherapy as Adjuvant for Locally Recurrent Breast Cancer) [CALOR; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00074152\u0026amp;atom=%2Fspmdc%2F12%2F20%2F14.2.atom\u0022\u003ENCT00074152\u003C\/a\u003E] trial, presented by Stefan Aebi, MD, Luzerner Kantonsspital, Lucerne, Switzerland, investigated the impact of chemotherapy on DFS and OS in patients with ILRR. The study had strong participation of the United States National Surgical Adjuvant Breast and Bowel Project, with Irene Wapnir, MD, from Stanford University, Stanford, California, USA, chairing the North American participation.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPatients with a first ILRR excised with negative or microscopically involved tumor margins and no evidence of tumor in supraclavicular lymph nodes or distant metastasis were eligible for the trial. After surgery, patients were stratified according to prior chemotherapy, estrogen receptor (ER) and\/or progesterone receptor (PR) status, and location of ILRR; they were then randomized to treatment with chemotherapy (n=85) or no chemotherapy (n=77). Patients with hormone receptor-positive cancers also received endocrine therapy, and those with human epidermal growth factor receptor 2 (HER2)-positive cancers could receive HER2-directed therapy. The specific chemotherapy was chosen by investigators, but a 2-drug regimen for 3 to 6 months was recommended. Radiation therapy at \u226540 Gy was required for patients with microscopically involved margins and recommended for all patients. The primary endpoint was DFS and the secondary endpoint was OS.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EBaseline characteristics were well balanced between the 2 groups. Therapies for ILRR received by patients in the chemotherapy versus no chemotherapy arms were radiation therapy (44% vs 39%), luteinizing hormone-releasing hormone (6% vs 13%), fulvestrant (0% vs 1%), tamoxifen (18% vs 18%), aromatase inhibitors (55% vs 53%), endocrine treatment for ER-positive ILRR (91% vs 92%), and HER2-directed therapies (7% vs 5%). Patients in the chemotherapy arm were treated with monotherapy (docetaxel or paclitaxel [20%], or capecitabine [11%]) or polychemotherapy (anthracycline-based [48%], anthracycline plus taxane-based [1%], or taxane-based [16%]). Therapies for ILRR in the chemotherapy arm are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14533\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14533\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14533\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ETherapies for ILRR in the Chemotherapy Arm.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EAt a median follow-up of 4.9 years, patients in the chemotherapy group versus the no-chemotherapy group had significantly improved DFS (69% vs 57%; HR, 0.59; 95% CI, 0.35 to 0.99; p=0.0455; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) and OS (88% vs 76%; HR, 0.41; 95% CI, 0.19 to 0.89; p=0.02).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/20\/14.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022DFS with Chemotherapy Versus No Chemotherapy.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-783252917\u0022 data-figure-caption=\u0022DFS with Chemotherapy Versus No Chemotherapy.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1:\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/20\/14.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/20\/14.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1:\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/20\/14.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14531\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1:\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EDFS with Chemotherapy Versus No Chemotherapy.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECT=chemotherapy; DFS=disease-free survival; Pts=patients.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from S Aebi, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EOn multivariate analysis controlling for ILRR location, disease-free interval, ER status, and prior adjuvant chemotherapy, the results remained significant for both DFS (HR, 0.50; p=0.01) and OS (HR, 0.37; p=0.02).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAnalysis by ER status showed a significant difference in DFS with chemotherapy versus no chemotherapy in ER-negative patients (DFS, 67% vs 35%; HR, 0.32; 95% CI, 0.14 to 0.73; p=0.007) but not in ER-positive patients (70% vs 69%; HR, 0.94; 95% CI, 0.47 to 1.89; p=0.87).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIn the CALOR trial, adjuvant chemotherapy reduced the risk of DFS events by 41% and death by 59%. The authors concluded that adjuvant chemotherapy should be recommended for patients with completely resected isolated local or regional recurrences. The results are strongest for patients with ER-negative recurrences. Longer follow-up is needed for patients with ER-positive recurrences.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/20\/14.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzo4we\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo4we\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzo4we\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}