Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients With Locally Advanced Breast Cancer Requiring Initial Mastectomy

Barranger, Emmanuel; Antomarchi, Julie; Chamorey, Emmanuel; Cavrot, Constance; Flipo, B.; Follana, Philippe; Peyrottes, Isabelle; Chapellier, C.; Ferrero, Jean Marc; Ihraï, T.

doi:10.1016/j.clbc.2015.03.001

Cited by 33 publications

(43 citation statements)

References 15 publications

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“…Previous studies [20,21] demonstrated that OS rates were not statistically different between the BCS group and the mastectomy group. However, our meta-analysis indicated that 5-year OS rates were improved for women who were able to undergo BCS after NCT as compared with those who underwent mastectomy, suggesting that being a candidate for BCS after NCT may be a proxy for tumor biology.…”

Section: Discussionmentioning

confidence: 79%

Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Zhou

2016

Breast Care

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Background: Breast-conserving surgery (BCS) in patients with large tumors shrunk by neoadjuvant chemotherapy (NCT) remains controversial. We conducted a meta-analysis to evaluate the local recurrence rates in locally advanced breast cancer (LABC) patients receiving NCT comparing BCS with mastectomy. Methods: Pubmed, Web of Knowledge, and Ovid's database were searched for studies concerning treatment for LABC from January 2000 to June 2015. A meta-analysis was performed to compare the recurrence rates of patients receiving BCS versus mastectomy following NCT. Results: 8 trials with a total of 3,215 patients were analyzed. The prevalence of local recurrence was 9.2% in the BCS group versus 8.3% in the mastectomy group without significant difference (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.28-1.48; p = 0.66). The 5-year local recurrence-free survival (LRFS) rate was lower in the mastectomy group than in the BCS group, but no significant difference was found between the 2 groups (OR 1.11, 95% CI 0.61-1.99; p = 0.74). Conclusion: BCS after NCT is safe in terms of local recurrence and LRFS in LABC women. Shrinking tumors with NCT provides the opportunity to apply BCS with no detriment to outcome.

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Section: Discussionmentioning

confidence: 79%

Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Zhou

2016

Breast Care

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“…However, for future applicability of fluorescence imaging in breast cancer surgery, the most added value is to be expected in BCS. Moreover, a significant number of patients with breast carcinoma is pre-treated with neoadjuvant systemic chemotherapy to reduce the primary tumor to facilitate BCS instead of radical mastectomy [40]. Although pre-treatment with systemic therapy does not result in an increased number of positive resection margins [41], recognition of vital tumor tissue can be challenging.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative imaging of folate receptor alpha positive ovarian and breast cancer using the tumor specific agent EC17

et al. 2016

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IntroductionIntraoperative fluorescence imaging of the folate-receptor alpha (FRα) could support completeness of resection in cancer surgery. Feasibility of EC17, a FRα-targeting agent that fluoresces at 500nm, was demonstrated in a limited series of ovarian cancer patients. Our objective was to evaluate EC17 in a larger group of ovarian cancer patients. In addition, we assessed the feasibility of EC17 in patients with breast cancer.MethodsTwo-to-three hours before surgery 0.1mg/kg EC17 was intravenously administered to 12 patients undergoing surgery for ovarian cancer and to 3 patients undergoing surgery for biopsy-proven FRα-positive breast cancer. The number of lesions/positive margins detected with fluorescence and concordance between fluorescence and tumor- and FRα-status was assessed in addition to safety and pharmacokinetics.ResultsFluorescence imaging in ovarian cancer patients allowed detection of 57 lesions of which 44 (77%) appeared malignant on histopathology. Seven out of these 44 (16%) were not detected with inspection/palpation. Histopathology demonstrated concordance between fluorescence and FRα- and tumor status. Fluorescence imaging in breast cancer patients, allowed detection of tumor-specific fluorescence signal. At the 500nm wavelength, autofluorescence of normal breast tissue was present to such extent that it interfered with tumor identification.ConclusionsFRα is a favorable target for fluorescence-guided surgery as EC17 produced a clear fluorescent signal in ovarian and breast cancer tissue. This resulted in resection of ovarian cancer lesions that were otherwise not detected. Notwithstanding, autofluorescence caused false-positive lesions in ovarian cancer and difficulty in discriminating breast cancer-specific fluorescence from background signal. Optimization of the 500nm fluorophore, will minimize autofluorescence and further improve intraoperative tumor detection.

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“…Emmanuel et al [17] reported 29 patients with LABC operated by oncoplastic surgery among 119 cases, Also a prospective clinical trial done by Mathes et al…”

Section: Discussionmentioning

confidence: 99%

“…We determined tumor size in our patients clinically and radiologically, The mean size before NCT 5.23 ± 0.85 cm (range 3.5 -6.8 cm) And after NCT 4.06 ± 0.70 cm (range 2.8 -5.5 cm), In the study conducted by Emmanuel et al [17] the initial mean size 41.6 mm before and 25.3 mm after NCT in study on 119 patient (29 had oncoplastic surgery), Veira et al [16] reported initial tumor size 5.26 cm in 26 patients with LABC underwent OS, The term extreme oncoplasty was first described by Silverstein [20] who published data on 66 patients with mean size 77 mm.…”

Section: Discussionmentioning

confidence: 99%

Oncoplastic Breast Surgery after Neoadjuvant Chemotherapy Replacing Mastectomy in Locally Advanced Breast Cancer (LABC): Single Institute Experience

Ghamrini¹,

Morad²,

Elsadek³

et al. 2017

JCT

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Background: Integration of neoadjuvant chemotherapy (NCT) in early 70s resulted that many LABC tumors become resectable but with total mastectomy especially those with partial response, oncoplastic techniques give better oncological outcome with better cosmetic results. Objective: We evaluate the oncological safety of oncoplastic breast surgery (OS) in LABC showing partial response to NCT. Methods: We prospectively analyzed the data of 32 out of 58 patients with LABC who showed partial response to NCT and could have conservative surgery with advanced oncoplastic techniques rather than total mastectomy. Results: Out of 58 patients with LABC, received neoadjuvant chemotherapy, complete response was observed in 8 patients (13%), partial response reported in 32 (55.1%) cases, 12 patients (20%) had stable disease and 6 patients (10%) showed progressive disease. Data of 32 cases were studied (mean age 44.84 ± 9.10 years; range 26 -59 years). Inferior pedicle was performed in 9 cases, mini LD flap in 3 patients, 5 had Grissotti technique, 6 with superomedial pedicle, 4 had V mammoplasty and 3 with J mammoplasty and 2 had vertical mammoplasty. Margins were positive in 5 cases (15.6%) with mean margin width 9.63 ± 5.72 (range 0 -22 mm), and the local recurrence was reported in 2 cases (6.2%). Complications were reported in 3 cases (9.3%). The follow up was 1.67 ± 1.03 (range 0 -3.3 years). Conclusions: Integration of neoadjuvant chemotherapy together with advanced oncoplastic techniques opens a new way for management of LABC especially those showing partial response with avoidance of total mastectomy, and comparable oncological safety in addition to better aesthetic and psychological outcome.

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Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients With Locally Advanced Breast Cancer Requiring Initial Mastectomy

Cited by 33 publications

References 15 publications

Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Intraoperative imaging of folate receptor alpha positive ovarian and breast cancer using the tumor specific agent EC17

Oncoplastic Breast Surgery after Neoadjuvant Chemotherapy Replacing Mastectomy in Locally Advanced Breast Cancer (LABC): Single Institute Experience

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