Evaluation of Discordance in Primary Tumor and Lymph Node Response After Neoadjuvant Therapy in Breast Cancer

Fleming, Christina; McCarthy, K N; Ryan, Ciara; McCarthy, Andréa; O’Reilly, Seamus; O’Mahony, Deirdre; Browne, Tara Jane; Redmond, Paul; Corrigan, Mark

doi:10.1016/j.clbc.2017.11.016

Cited by 13 publications

(7 citation statements)

References 47 publications

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“…The main reason for the asynchrony between them may be related to the special structure of lymph nodes or the particularity of peripheral blood circulation. In addition, it may also represent that due to biological heterogeneity, the occult regional or systemic metastases have poor response to chemotherapy [ 20 ]. Moreover, the postoperative DFS time of the patient was more than 3 months, which proved the effectiveness of immunotherapy combined with chemotherapy, and further predicted a good prognosis.…”

Section: Discussionmentioning

confidence: 99%

Asynchrony of primary tumor and mediastinal lymph nodes response after neoadjuvant immunotherapy plus chemotherapy in a patient with stage IIIA non–small-cell lung cancer: a case report

Liu¹,

Gao²,

Zhang

et al. 2021

Anti-Cancer Drugs

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With the rapid development of immunotherapy, the efficacy and feasibility of neoadjuvant immunotherapy for early resectable non–small-cell lung cancer (NSCLC) has been demonstrated. However, there are still difficulties and controversies in evaluating the efficacy of neoadjuvant immunotherapy. In our report, we described a 43-year-old female patient who was diagnosed with stage IIIA (cT1N2M0) pulmonary adenocarcinoma. After two cycles of neoadjuvant immunotherapy (sintilimab) combined with chemotherapy, according to imaging evaluation, the efficacy of the primary lesion was evaluated as stable disease and the mediastinal lymph nodes were evaluated as partial response. However, the postoperative pathological evaluation showed the primary lesion was pathological complete response and the mediastinal lymph nodes were major pathological response. This indicated that neoadjuvant chemo-immunotherapy was effective for both primary and mediastinal lymph nodes, but regression of the lesions was not synchronous. This study provided a complete process of neoadjuvant treatment, illustrating the effectiveness and safety of neoadjuvant chemo-immunotherapy to a certain extent. It is also suggested that the evaluation of neoadjuvant immunotherapy should be combined with imaging and pathology, and the primary tumor and lymph nodes should be evaluated, respectively.

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Section: Discussionmentioning

confidence: 99%

Asynchrony of primary tumor and mediastinal lymph nodes response after neoadjuvant immunotherapy plus chemotherapy in a patient with stage IIIA non–small-cell lung cancer: a case report

Liu¹,

Gao²,

Zhang

et al. 2021

Anti-Cancer Drugs

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“…2). Moreover, the inconsistency of chemotherapy sensitivity between the primary tumor and metastatic lymph nodes has also been reported in several other types of cancer, including lung cancer, gastric cancer, breast cancer, and colorectal cancer 21–25 …”

Section: Discussionmentioning

confidence: 95%

Gemcitabine Versus Docetaxel Plus Cisplatin as Induction Chemotherapy in Nasopharyngeal Carcinoma

Chen

2022

The Laryngoscope

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Objectives: To compare tumor volume reduction after induction chemotherapy (IC) with gemcitabine plus cisplatin (GP) and docetaxel plus cisplatin (DP) and to evaluate the influence on subsequent radiotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC).Study Design: Retrospective clinical study. Methods: Patients who received GP or DP IC followed by concurrent chemoradiotherapy (CCRT) were retrospectively enrolled. Propensity score matching (PSM) was adopted to control the balance between the GP and DP groups.Results: A total of 41 patients treated with GP and 53 patients treated with DP were enrolled. After matching, 33 subpairs of 66 patients were generated in the post-PSM cohort. As compared with DP, GP was superior in its gross tumor volume of the nasopharynx (GTVnx) reduction (28.88% vs. 18.73%; P = .014) but equivalent in its gross tumor volume of the lymph nodes (GTVnd) reduction (37.58% vs. 29.79%; P = .229). Univariate and multivariate analyses confirmed that the chemotherapy regimen was an independent factor associated with the reduction in GTVnx (P = .011). The GP group exhibited advantages in the dosimetric parameters of the planning target volume of high-risk volume and low-risk volume (PTV1 and PTV2), lenses, temporal lobes, and parotid glands. Univariate and multivariate analyses confirmed that chemotherapy regimen was an independent factor associated with the dosimetric parameters of PTV1, PTV2, lenses, temporal lobes, and parotid glands.Conclusion: GP regimen achieves a greater GTVnx reduction than DP regimen and has an advantage in the dosimetry of subsequent CCRT.

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“…This may be a result of error in clinical axillary examination and tumor heterogeneity that has been reported between the primary tumor and nodal foci of tumor. 27 …”

Section: Discussionmentioning

confidence: 99%

Sterilization Rate of the Axilla After Neoadjuvant Chemotherapy: The Scope for Conservative Surgery

Noronha

Joshi

Hawaldar

et al. 2020

JCO Global Oncology

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PURPOSE The role of axillary conservation after neoadjuvant chemotherapy (NACT) is debatable. We routinely carry out complete axillary lymph node dissection (ALND). This study was conducted to understand the pathologic axillary complete response (pAxCR) after NACT. MATERIALS AND METHODS We evaluated a prospective database of patients with breast cancer who underwent surgery after NACT in the year 2017 at our institution. NACT was administered to downstage locally advanced breast cancer or facilitate breast-conservation surgery. RESULTS Of 793 patients who underwent surgery after NACT, 97(12.2%) had cN0 disease, 407 (51.3%) had cN1, 262 (32%) had cN2, and 27 (3.4%) had cN3 at presentation. Eighty-eight patients (11.1%) had cT1-2 primary tumor stage, and 623 patients (78.6%) had cT3-4 primary tumor stage; primary tumor stage details were unavailable for 82 patients (10.3%). The median age was 46 years (range, 21-74 years). On histopathology, the overall pAxCR rate was 52.8%. In the cN1 and cN2 settings, 58.7% and 36.6% of patients achieved ypN0 status, respectively. The overall pathologic complete response rate was 22.64% (161 of 711 patients). On univariable analysis, cN stage, histologic grade, hormone receptor status, NACT duration, and lymphovascular invasion were significantly associated with pAxCR ( P <.001). On logistic regression, prechemotherapy cN status (odds ratio [OR], 3.08; 95% CI, 2.18 to 4.37; P <.001), estrogen and progesterone receptor status (OR, 0.34; 95% CI, 0.3 to 0.4; P <.001), and administration of both chemotherapy regimens preoperatively (OR, 0.66; 95% CI, 0.45 to 0.97; P <.05) predicted pAxCR. CONCLUSION At least half of patients with cN1 and a third of patients with cN2 breast cancer who develop pAxCR may be suitable candidates for axillary conservation. A careful postchemotherapy assessment followed by a conservative axillary procedure may be an alternative to ALND, but this needs to be studied prospectively.

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Evaluation of Discordance in Primary Tumor and Lymph Node Response After Neoadjuvant Therapy in Breast Cancer

Cited by 13 publications

References 47 publications

Asynchrony of primary tumor and mediastinal lymph nodes response after neoadjuvant immunotherapy plus chemotherapy in a patient with stage IIIA non–small-cell lung cancer: a case report

Asynchrony of primary tumor and mediastinal lymph nodes response after neoadjuvant immunotherapy plus chemotherapy in a patient with stage IIIA non–small-cell lung cancer: a case report

Gemcitabine Versus Docetaxel Plus Cisplatin as Induction Chemotherapy in Nasopharyngeal Carcinoma

Sterilization Rate of the Axilla After Neoadjuvant Chemotherapy: The Scope for Conservative Surgery

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