Breast conservation after neoadjuvant chemotherapy

Abstract

BACKGROUND The appropriate selection criteria for breast‐conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision‐making for patients treated by this multimodality approach. METHODS From a group of 340 patients treated with BCT after neoadjuvant chemotherapy, the authors previously determined 4 statistically significant predictors of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR): clinical N2 or N3 disease, residual pathologic tumor size > than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The M. D. Anderson Prognostic Index (MDAPI) was developed by assigning scores of 0 (favorable) or 1 (unfavorable) for each of these 4 variables and using the total to give an overall MDAPI score of 0–4. RESULTS The MDAPI stratified the 340 patients into 3 subsets with statistically different levels of risk for IBTR and LRR after neoadjuvant chemotherapy and BCT. Actuarial 5‐year IBTR‐free survival rates were 97%, 88%, and 82% for patients in the low (MDAPI overall score 0 or 1, n = 276), intermediate (MDAPI score 2, n = 43), and high (MDAPI score 3 or 4, n = 12) risk groups, respectively (P < 0.001). Corresponding actuarial 5‐year LRR‐free survival rates were 94%, 83%, and 58%, respectively (P < 0.001). CONCLUSIONS Patients with an MDAPI score of 0 or 1, which made up 81% of the study population, had very low rates of IBTR and LRR. The MDAPI enabled the identification of a small group (4%) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies. Cancer 2005. © 2005 American Cancer Society.

Concordance of clinical and molecular breast cancer subtyping in the context of preoperative chemotherapy response

“…None of the three approaches to further subdivide the ER? IHC /HER2-IHC group appears to result in better predictors of chemotherapy response, despite the fact that the prognostic power of each of these has been well documented [34][35][36][37][38][39]. Although the Luminal tumors in general do not reach a pCR, a significant proportion (53%) of these achieve a reduction in primary (breast) tumor volume of at least 50%.…”

“…Although the Luminal tumors in general do not reach a pCR, a significant proportion (53%) of these achieve a reduction in primary (breast) tumor volume of at least 50%. Treatment of these tumors with chemotherapy can allow breast-conserving surgery to take place [34][35][36][37][38][39] and as such can be an effective treatment option for this group. The Normal-like subgroup is so small that no conclusions can be drawn at this moment.…”

Preoperative chemotherapy is safe in early breast cancer, even after 10 years of follow-up; clinical and translational results from the EORTC trial 10902

“…In the same center, an index was developed on a scale of 0-4 which identified subgroups of patients with significantly different rates of LRR after chemotherapy followed by BCT [19,20]. Patients with a score of 4 had a higher chance of LRR than patients with a lower score.…”

Colorectal liver metastases contract centripetally with a response to chemotherapy

“…In breast cancer, for example, it is often possible to perform breast-conserving therapy after a favorable response to neoad- juvant chemotherapy, and this is associated with a low rate of locoregional recurrence. 28,29 Similarly, in the setting of rectal cancer, it is feasible to avoid an abdominoperineal resection in a greater proportion of patients after neoadjuvant chemotherapy, with survivals comparable to patients who did not receive neoadjuvant chemotherapy who underwent abdominoperineal resection. 30 Therefore, as with other tumor models, with appropriate margins liver-sparing resections are possible, and these are unlikely to adversely affect outcomes.…”