BACKGROUND: Experimental data on perioperative chemotherapy (PeCT) indicate that 
its initiation might be most useful if administered as close as possible to the 
time of first 'disturbance of the tumour'. Regimens including 5-fluorouracil 
(5-FU) as continuous infusion are commonly used in the preoperative setting, 
especially for large tumours and locally advanced disease. We therefore 
evaluated the role of PeCT with 5-FU as continuous infusion after preoperative 
chemotherapy (PreCT), covering the surgical phase and acute wound healing 
period, in patients with breast cancer too large to attempt breast-conserving 
surgery upon diagnosis.
PATIENTS AND METHODS: Breast cancer patients, clinical stages T2-T3, N0-N2, M0, 
and Ki-67 labelling index >/= 20%, were treated every 3 weeks with a maximum of 
six courses of vinorelbine 20 mg total dose intravenously (i.v.) on days 1 and 
3, cisplatin 60 mg/ m(2) i.v. on day 1 and 5-FU 200 mg/m(2)/day as a continuous 
infusion (ViFuP regimen). Patients who achieved a clinical and radiological 
objective remission with PreCT were also treated with perioperative 5-FU that 
was continued until 30 min before, and restarted immediately after surgery, 
prolonging infusion until 15 days after surgery.
RESULTS: Following preoperative treatment, 39 of 49 evaluable patients [80%; 95% 
confidence interval (CI) 70% to 90%] had an objective response. Pathological 
complete remission (pCR) was achieved in 14 (29%) patients. No relevant clinical 
or haematological toxicity due to PeCT was observed. In 36 patients submitted to 
PeCT the rate of pCR was 33% (95% CI 18% to 48%). The highest response of the 
primary tumour to PreCT and PeCT was observed in women with tumours not 
expressing estrogen and progesterone receptors (pCR 46%; 95% CI 19% to 73%).
CONCLUSIONS: Preoperative therapy can be protracted into the surgical (and wound 
healing) period without significant additional short-term toxicity. Proper 
selection of patients according to biological features might improve the 
therapeutic yield of preoperative therapies.