Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

Abstract

OBJECTIVE:To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer.METHODS:A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival.RESULTS:Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01).CONCLUSIONS:Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.

Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes

“…Excision volumes in patients undergoing BCS after NACT were reported in fifteen studies, including two prospective cohort studies and thirteen retrospective studies [ 20 , 25 , 27 , 28 , 31 , 33 , 39 , 40 , 42 , 44 , 45 , 47 , 48 – 50 ]. Thirteen studies were single-center studies.…”

“…Additionally, ten single-center cohort studies reported excision volumes or specimen weight after NACT without comparing these results with another group. A large heterogeneous patient population was included, and a wide range of excision volumes (43.7–268 cm 3 ) and specimen weight (48–233 g) was reported [ 20 , 39 , 40 , 42 , 44 , 45 , 47 , 48 – 50 ].…”

“…From the studies included in this systematic review, pCR rates range from 12 to 40.4%. [ 20 , 31 , 39 , 40 , 44 , 47 – 50 ] By definition, these patients will have tumor-free resection margins, and therefore, the estimated percentages of involved margins are actually an underestimate in those patients who have residual disease after NACT. Currently, while the search continues for optimal preoperative imaging to predict response to NACT, the definitive response to chemotherapy is still determined postoperatively by a pathologist.…”

Disease-free and overall survival after neoadjuvant chemotherapy in breast cancer: breast-conserving surgery compared to mastectomy in a large single-centre cohort study

“…This difference did not hold after correcting for confounders. A few other 'neoadjuvant' cohort studies reported on the oncologic safety of BCS [20][21][22][23][24]. All reported that BCS did not affect survival compared to mastectomy.…”

Upregulating MMP‑1 in carcinoma‑associated fibroblasts reduces the efficacy of Taxotere on breast cancer synergized by Collagen IV

“…Nevertheless, due to chemotherapy resistance and the lack of effective predictors, the clinical efficacy of chemotherapy is limited. Disease relapse may occur in months or years, due to chemotherapeutic resistance acquired during treatment (3,4). There are two types of chemotherapy resistance, the first is intrinsic resistance which is predominantly related to the heterogeneity of tumor cells due to tumor stem cells (5,6), and the other is acquired resistance, which occurs over the course of treatment (7).…”