Neoadjuvant chemotherapy in operable breast cancer

Scholl, Suzy; Asselain, Bernard; Palangié, T; Dorval, Thierry; Jouve, M; Giralt, E.; Vilcoq, J.R.; Durand, Jean‐Claude; Pouillart, P

doi:10.1016/0277-5379(91)90442-g

Cited by 86 publications

(51 citation statements)

References 3 publications

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“…Predictive value of 'tumour response' Neither tumour response to primary chemotherapy nor local treatment were correlated with subsequent patient outcome in our series, in contrast to other reports (Feldman et al, 1986;Jacquillat et al, 1990;Scholl et al, 1991;Calais et al, 1994). Ideally, tumour regression should have been confirmed by microscopic analysis, but this was impossible, because of the construction of our clinical trial.…”

Section: Predictive Value Of 'Proliferative Index'contrasting

confidence: 75%

Primary chemotherapy in breast invasive carcinoma: predictive value of the immunohistochemical detection of hormonal receptors, p53, c-erbB-2, MiB1, pS2 and GST pi

MacGrogan

Mauriac²,

Durand³

et al. 1996

Br J Cancer

168

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Summary Primary chemotherapy in operable breast invasive carcinoma enables tumour reduction and conservative surgery. In order to search for one or more biological factors capable of predicting tumour behaviour under primary chemotherapy, and subsequent patient survival, an immunohistochemical study was performed with specific antibodies to p53, c-erbB-2 (Her-2/neu), Mibl (antiKi-67), pS2, GSTir, oestrogen receptors (ERs) and progesterone receptors (PRs). Core biopsies, obtained before primary chemotherapy, were available from a series of 128 breast invasive carcinomas treated between January 1985 and April 1989, with a median follow-up of 93.3 months. Univariate statistical analysis showed that negative ER detection by immunohistochemistry (IHC) was highly correlated with chemosensitivity (P=0.001). A high percentage of Mibl-positive tumour cells (>40%), as well as initial tumour size less than 4 cm, were also correlated with tumour responsiveness to chemotherapy (P=0.009 and P=0.03). By multivariate analysis IHC-ER, Mibl and initial tumour size were independent predictors, the last parameter being the most important. Concerning subsequent patient survival, c-erbB-2 overexpression, as detected by IHC, was significant with respect to overall survival (OS) (P=0.0006), disease-free interval (DFI) (P=0.03) and metastasis-free interval (MFI) (P=0.008) by univariate analysis. Furthermore, c-erbB-2 was the major independent prognostic factor for OS and MFI by multivariate analysis.

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Section: Predictive Value Of 'Proliferative Index'contrasting

confidence: 75%

Primary chemotherapy in breast invasive carcinoma: predictive value of the immunohistochemical detection of hormonal receptors, p53, c-erbB-2, MiB1, pS2 and GST pi

MacGrogan

Mauriac²,

Durand³

et al. 1996

Br J Cancer

168

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“…For large tumors, it is our standard practice to give preoperative chemotherapy to downsize the tumor and resect the remaining palpable tumor after four to six cycles of chemotherapy. 9 However, pathologic examination of resected tissue in patients after chemotherapy has shown multiple foci of scattered residual tumor cells interspersed with marked fibrosis. 29 It may indeed be that it is necessary to remove a large margin of tissue around the residual tumor after initial chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] However, with BCT for large tumors, there can be difficulty in obtaining clear excision margins, and the cosmetic outcome is often poor. 10,11 The tumor size in relation to the breast size is one of the most important factors when attempting to obtain a cosmetically favorable result.…”

Section: Discussionmentioning

confidence: 99%

“…This included patients who had a poor or no response to preoperative chemotherapy 9 or radiotherapy 20 and patients for whom preoperative therapy was contraindicated because of their age or concurrent medical illness. We then extended the indications to patients who required a large excision margin for a poorly defined tumor or a large area of microcalcifications on the mammogram.…”

Section: Discussionmentioning

confidence: 99%

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Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas

Clough¹,

Lewis²,

Couturaud³

et al. 2003

Annals of Surgery

533

319

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ObjectiveTo assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast-conserving therapy using oncoplastic techniques with concomitant symmetrization of the contralateral breast. Summary Background DataAlthough breast-conserving therapy is the standard form of treatment for invasive breast tumors up to 4 cm, in patients with large, ill-defined, or poorly situated tumors, cosmetic results can be poor and clear resection margins difficult to obtain. The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. MethodsThis is a prospective study of 101 patients who were operated on for breast carcinoma between July 1985 and June 1999 at the Institut Curie. The procedure was proposed for patients in whom conservative treatment was possible on oncologic grounds but where a standard lumpectomy would have led to poor cosmesis. Standard institutional treatment protocols were followed. All patients received either pre-or postoperative radiotherapy. Seventeen patients received preoperative chemotherapy to downsize their tumors. Mean follow-up was 3.8 years. Results were analyzed statistically using Kaplan-Meier estimates. ResultsMean weight of excised material on the tumor side was 222 g. The actuarial 5-year local recurrence rate was 9.4%, the overall survival rate was 95.7%, and the metastasis-free survival rate was 82.8%. Cosmesis was favorable in 82% of cases. Preoperative radiotherapy resulted in worse cosmesis than when given postoperatively. ConclusionsThe use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma and results in favorable oncologic and esthetic outcomes. This approach might be useful in extending the indications for conservative therapy.

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“…Breast-conservation therapy can be performed in 450% of all cases, despite a nonnegligible rate of local recurrences (23.1 vs 8.7% for patients treated by adjuvant chemotherapy), without compromising patients' outcome (Mauriac et al, 1991). The quality of patients' response to this strategy, which is usually followed by locoregional therapy (surgery and/or radiotherapy), seems to be a prognostic factor in many studies (Scholl et al, 1991;Calais et al, 1994;Bonadonna et al, 1998;Brenin and Morrow, 1998;Ferriere et al, 1998). This has become a common approach for the treatment of a variety of neoplasms, including oesophageal, testicular, lung and breast cancers, osteosarcoma and squamous cell cancers of the head and neck.…”

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confidence: 99%

Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breast-conservation rate

et al. 2003

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Docetaxel (Taxotere s ), alone or in combination with other anticancer agents, has proven efficacy in the first-and second-line treatment of metastatic breast cancer. This phase II study investigated the efficacy and tolerability of docetaxel as neoadjuvant chemotherapy in women with stage II -III primary operable breast cancer. Patients (n ¼ 88) were treated with six cycles of docetaxel at 100 mg m À2 every 21 days, followed by definitive surgery and radiotherapy. After six cycles of docetaxel, the overall clinical response rate was 68.4% (CI 95%: 58.1 -78.7%), including 19.0% complete remissions. Breast conservation was achieved in 72.4% of patients. A high pathological complete response (pCR) rate in breast was confirmed in 15 patients (19.8% (CI 95%: 10.8 -28.8%)) on Chevallier's classification restricted to breast and in 27 patients (35.5% (CI 95%: 24.7 -46.3%)) on Sataloff's classification. After a median follow-up of 30.8 months, 19 recurrences were documented with a median time to first recurrence of 17.3 months. Patients with stage III tumours had more recurrences than patients with stage II tumours (P ¼ 0.02). The principal toxicity of docetaxel is myelosuppression and 70.5% of patients developed grade III or IV neutropenia with 13.6% developing neutropenic sepsis. There was no case of severe cardiac toxicity, thrombocytopenia or any other serious adverse events. In conclusion, neoadjuvant docetaxel induces a high pCR and breast-conservation rate. Docetaxel monotherapy is a highly effective regimen that merits formal comparison with currently used combination regimens in a randomised phase III study.

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Neoadjuvant chemotherapy in operable breast cancer

Cited by 86 publications

References 3 publications

Primary chemotherapy in breast invasive carcinoma: predictive value of the immunohistochemical detection of hormonal receptors, p53, c-erbB-2, MiB1, pS2 and GST pi

Primary chemotherapy in breast invasive carcinoma: predictive value of the immunohistochemical detection of hormonal receptors, p53, c-erbB-2, MiB1, pS2 and GST pi

Oncoplastic Techniques Allow Extensive Resections for Breast-Conserving Therapy of Breast Carcinomas

Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breast-conservation rate

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