Does the Timing of Surgery after Neoadjuvant Therapy in Breast Cancer Patients Affect the Outcome?

Abstract

<b><i>Background:</i></b>There is a paucity of literature examining the impact of timing of surgery after neoadjuvant chemotherapy. <b><i>Objective:</i></b>This study aimed to analyze the impact of the time taken to initiate surgical treatment following completion of neoadjuvant chemotherapy on patients’ outcomes by evaluating their pathological response, overall survival (OS), and disease-free survival (DFS). <b><i>Methods:</i></b>This is a retrospective review of 611 patients diagnosed with stage II and III breast cancer that received neoadjuvant chemotherapy and surgery between January 2004 and December 2014. The data was collected from a prospectively gathered registry. The patients were stratified into three cohorts according to the time of surgery after neoadjuvant chemotherapy: <4 weeks, 4–7 weeks, or ≥8 weeks. Outcomes were assessed using Kaplan-Meier curves, and the variables were compared using log-rank statistics. <b><i>Results:</i></b>The 5-year OS rate was 89.6% and the 5-year DFS rate was 74%. OS and DFS were not significantly different when stratified according to timing of surgery; however, the trends of OS and DFS were poor when surgery was delayed for ≥8 weeks. Median OS and median DFS have not yet been reached. Of the 17% of patients that had surgery after ≥8 weeks, 12.9% had pathological complete response (pCR), while among those that received surgery 4–7 weeks and <4 weeks after neoadjuvant chemotherapy, 26% and 21% had pCR, respectively (<i>p</i> = 0.02). ER+/HER-2+ patients had a statistically significant decrease in pCR if surgery was performed after ≥8 weeks. <b><i>Conclusion:</i></b>Our patients showed improved pCR if surgery was performed within 8 weeks, especially for ER+/HER-2+ patients. All patients had better OS and DFS trends if surgery was performed between 4 and 7 weeks after neoadjuvant chemotherapy.

Impact of neoadjuvant chemotherapy on perioperative morbidity after major surgery for head and neck cancer

“…32 To the best of our knowledge, the available literature demonstrated a strong focus in other malignancies such as breast and gastric cancer, indicating that a 4-week interval may be a safe compromise. 33,34 Further studies on this topic in patients with HNC will help to guide the optimal timing of surgery and oncologic outcomes. However, notwithstanding individual patient factors, it appears that 3 weeks is a reasonable time interval between the last cycle of NAC and surgery for the most commonly used chemotherapy regimens in patients with HNC without increasing the risk of perioperative complications.…”

The relationship between time to surgery(TTS) after neoadjuvant chemotherapy (NAC)and survival in breast cancer patients: meta-analysis

“…Eight systematic reviews, four studies on metastatic breast cancer, and eleven non-neoadjuvant chemotherapy were further excluded. Eventually, nine articles [11][12][13][14][15][16][17][18][19] (eight studies) were identi ed as eligible for our analysis, including eight independent studies for OS, six studies for RFS, and two for DFS [14]. The ow chart of the literature search and study selection is shown in Fig.…”

The relationship between time to surgery after neoadjuvant chemotherapy and survival in breast cancer patients:a meta-analysis

“…Data synthesis:A total of four hundred and ve potentially relevant publications were found according to our initial search strategy,one hundred and sixteen publications from PubMed/Medline,two hundred and eighty-nine publications from Embase.There were three hundred and one publications after duplicate publications were removed;of these,we excluded two hundred and sixty-eight articles because the title or abstract did not meet the eligibility criteria.Eight systematic reviews,four studies on metastatic breast cancer,and eleven non-neoadjuvant chemotherapy were further excluded. Eventually,nine studies were identi ed as eligible for our analysis,including nine independent studies for OS [11][12][13][14][15][16][17][18][19],six studies for RFS [11,12,[15][16][17][18],and three for DFS [13,14,19].The ow chart of the literature search and study selection is shown in gure 1. Subsequently,subgroup analysis was performed based on different time intervals.…”