[Adjuvant chemotherapy of breast cancer: an international review and the Swiss experience].

Initially somewhat exaggerated expectations about increased cure rates from adjuvant chemotherapy in operable breast cancer have been fulfilled only partially up to this date. However, most of the randomized, prospective and all of the historically controlled trials have revealed significantly decreased relapse and (less impressive) also death rates (expected mortality ratio) 5 and more years after mastectomy. Not all patient subgroups seem to benefit equally from adjuvant chemotherapy: its effectiveness seems to be more pronounced in pre- than in post-menopausal women and in those with only 1-3 instead of 4 and more tumor-positive homolateral axillary lymph nodes. Adjuvant combination chemotherapy seems to be more effective than monochemotherapy. Shortening of adjuvant CMF from 12 to 6 cycles gives the same result with definitely less toxicity. Adjuvant Tamoxifen probably is yielding similar results as adjuvant CMF (or other combinations) in post-menopausal, hormone-receptor positive women, but neither its long-term impact on survival nor the necessary treatment duration with antiestrogens are clearly known today. The value of adjuvant chemo- and hormone-therapy in node-negative women is still controversial, although at least hormone-receptor negative, node-negative patients exhibit the same risk of relapse and ultimate prognosis as do node-positive women. After 8-15 years of median follow-up in controlled studies, there seems to be no increased, but rather a decreased risk of second malignancies and also late leukemias in women treated with temporary adjuvant chemotherapy. Optimizing effectiveness and practicability of adjuvant chemo- (and also hormono-) therapy requires additional carefully controlled clinical studies, especially in high risk patients with more than 3 tumor-positive axillary nodes.