Breast Conservation After Neoadjuvant Chemotherapy: The M.D. Anderson Cancer Center Experience

Chen, Allen M.; Meric‐Bernstam, Funda; Hunt, Kelly K.; Thames, Howard D.; Oswald, Mary Jane; Outlaw, Elesyia D.; Strom, Eric A.; McNeese, Marsha D.; Kuerer, Henry Mark; Ross, Merrick I.; Singletary, S. Eva; Ames, F. C.; Feig, Barry W.; Şahin, Ayşegül; Perkins, George H.; Schechter, Naomi R.; Hortobágyi, Gabriel N.; Buchholz, Thomas A.

doi:10.1200/jco.2004.09.062

Cited by 369 publications

(261 citation statements)

References 47 publications

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“…Of the 268 patients treated with breast conserving surgery, 18 (7%) had radial margins involved by invasive carcinoma and 11 (4%) were recorded as having close surgical margins. These numbers compare favourably with another single institution series of 340 patients treated with neoadjuvant chemotherapy followed by breast conserving surgery (Chen et al, 2004). There have been a number of proposed methods for assessing pathological response to neoadjuvant chemotherapy in the treatment of early and locally advanced breast cancer.…”

Section: Discussionmentioning

confidence: 83%

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

et al. 2006

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Patients who have no residual invasive cancer following neoadjuvant chemotherapy for breast carcinoma have a better overall survival than those with residual disease. Many classification systems assessing pathological response to neoadjuvant chemotherapy include residual ductal carcinoma in situ (DCIS) only in the definition of pathological complete response. The purpose of this study was to investigate whether patients with residual DCIS only have the same prognosis as those with no residual invasive or in situ disease. A retrospective analysis of a prospectively maintained database identified 435 patients, who received neoadjuvant chemotherapy for operable breast cancer between February 1985 and February 2003. Of these, 30 (7%; 95% CI 5 -9%) had no residual invasive disease or DCIS and 20 (5%; CI 3 -7%) had residual DCIS only. With a median follow-up of 61 months, there was no statistical difference in disease-free survival, 80% (95% CI 60 -90%) in those with no residual invasive or in situ disease and 61% (95% CI 35 -80%) in those with DCIS only (P ¼ 0.4). No significant difference in 5-year overall survival was observed, 93% (95% CI 75 -98%) in those with no residual invasive or in situ disease and 82% (95% CI 52 -94%) in those with DCIS only (P ¼ 0.3). Due to the small number of patients and limited number of events in each group, it is not possible to draw definitive conclusions from this study. Further analyses of other databases are required to confirm our finding of no difference in disease-free and overall survival between patients with residual DCIS and those with no invasive or in situ disease following neoadjuvant chemotherapy for breast cancer.

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Section: Discussionmentioning

confidence: 83%

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

et al. 2006

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Nes

Putter

Julien³

et al. 2008

Breast Cancer Res Treat

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International audienceThe Preoperative Chemotherapy in Primary Operable Breast Cancer (POCOB) study was designed to compare preoperative with postoperative chemotherapy in patients with early breast cancer concerning breast conserving therapy (BCT) procedures, disease free survival (DFS) and overall survival (OS). Patients ( = 698) with early breast cancer were enrolled between 1991 and 1999 and randomized between preoperative versus postoperative chemotherapy (four cycles of fluorouracil, epirubicin, and cyclophosphamide). Endpoints were BCT procedures, DFS, OS, and tumor response to preoperative chemotherapy. In addition, tumor tissue was collected for translational research and the following markers were examined: ER, PgR, HER2, p21, p53, and bcl-2 expression. With a median follow-up of 10 years, there was no statistically significant difference between the two treatment arms for OS (HR = 1.09; 95%CI 0.83–1.42; = 0.54), DFS (HR = 1.12; 95%CI 0.90–1.39; = 0.30), or locoregional recurrences (LRR, HR = 1.16; 95%CI 0.77–1.74). Preoperative chemotherapy was associated with an increase in BCT rates. BCT in part feasible due to tumor downsizing after preoperative chemotherapy was not correlated with higher LRR or worse OS compared to BCT which was feasible without downsizing of the tumor. Using available tumor material, only tumor stage, nodal stage, and grade were independent prognostic factors for overall survival. Preoperative chemotherapy does not result in a difference in OS or DFS compared to postoperative chemotherapy in patients with early breast cancer. Moreover, it increases BCT rates with no significant increase of LRR. This implies that preoperative chemotherapy is a safe procedure for patients with early breast cancer, even after a follow-up period of 10 years

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“…For some authors, the diversity of pathologic findings indicates the need for mastectomy [16,17]. Other authors argue that the low recurrence rates reported in selected cases of T3 and T4 show that these patients could rather undergo conserving surgery [3,18]. This study indicates that oncoplastic surgical techniques are a useful approach to achieve this aim of getting adequate margins as well as achieving a cosmetically acceptable breast conservation.…”

Section: Discussionmentioning

confidence: 87%

“…The possibility of breast conservation in cases of LABC has been demonstrated in single-institution experiences with small numbers and long follow-up. There are also single institutional experiences with large number of LABC patients, but with short follow-up results [2][3][4]. The only prospective randomized trial, LAMANOMA, failed due to insufficient accrual of the patients [5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

Chauhan

Sharma

Kumar

2016

Indian J Surg Oncol

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The purpose of this study was to compare early oncologic outcomes of oncoplastic breast surgery and conventional breast conservation surgery in patients of locally advanced breast cancer. A single-center, prospective, nonrandomized study enrolled select cases of locally advanced breast cancer (TNM T3/T4, N0/1/2) who after neoadjuvant chemotherapy, were considered for breast conservation surgery with oncoplasty techniques. The specimen volume resected, the mean margins and mean closest margin obtained were noted. The re-surgery rates, complication rates, and incidence of locoregional recurrence were also noted. Variables were compared with a retrospective cohort of similar patients who had undergone conventional breast conservation surgery. Fifty-seven patients underwent OBS (group 1) and were compared with 43 cases that had undergone conventional BCS (group 2). Majority of the patients in group 1 (73 %) had cT3 with N0 or N+ and a minority (17 %) were with limited skin involvement (cT4 and N0/N+). Relatively larger sized, post-NACT tumors could undergo OBS(4.4 vs 2.3 cm). Relatively greater proportion of tumors in central and lower quadrants were addressed by oncoplasty than traditional BCS (17/57, 29 % vs 4/43, 9 %, p = 0.04). The mean specimen volume excised in group 1 was more than that in group 2. (187.54 vs 125.19; p = 0.01). The mean of the margins were obtained more in group 1 (1.04 vs 0.69 cm); p < 0.01) as also the mean closest margin (0.86 vs 0.49 cm; p < 0.01). The incidence of close or involved margins was lesser in the OBS group (8 vs 24 %). Overall incidence of complications was similar in both groups (8/57, 14 % vs 4/43, 9 %; p = 0.34 NS). The median follow-up period of group 1 is 18 months (range 06-30 months) while group 2 is 34 months (14-44 months. There was no recurrence in group 1, but there were 5 cases (11 %) in group 2. Oncoplasty breast surgery offers more opportunity for breast conservation and oncologic safety than conventional breast conserving surgery.

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Breast Conservation After Neoadjuvant Chemotherapy: The M.D. Anderson Cancer Center Experience

Cited by 369 publications

References 47 publications

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

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

Evaluation of Surgical Outcomes of Oncoplasty Breast Surgery in Locally Advanced Breast Cancer and Comparison with Conventional Breast Conservation Surgery

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