Oncologic safety of breast‐conserving surgery compared to mastectomy in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer

Cho, Jung Hoon; Park, Ji Min; Park, Hyung Seok; Park, Seho; Kim, Kyung Sik; Park, Byeong Woo

doi:10.1002/jso.23439

Cited by 69 publications

(60 citation statements)

References 25 publications

(27 reference statements)

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“…We also achieved the main objective of NACT, which is to improve the quantity of breast conservation surgeries. There is evidence that NACT improves opportunities to apply breast-conserving surgery without compromising the patients' outcomes [23]. In this study, we could confirm this result showing a rate of 58.8% of breast conservation surgeries in our population.…”

Section: Discussionsupporting

confidence: 76%

Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease

et al. 2015

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Objective: Neoadjuvant chemotherapy (NACT) allows for a more frequent use of breast-conservative surgery; it is also an in vivo model of individual tumor sensitivity which permits to determine new prognostic factors to personalize the therapeutic approach. Methods: Between 2000 and 2012, 318 patients with primary invasive breast cancer were treated with a median of 6 cycles of NACT; they received either an anthracycline-based FEC 100 protocol (31.1%), or anthracyclines + taxanes (53.5%), with trastuzumab if indicated (15.4%). Results: After a median follow-up of 44.2 months, the pathological complete response rate according to the classification of Chevallier et al. [Am J Clin Oncol 1993;16:223-228] was 19.3%, and overall (OS) and disease-free survival (DFS) at 10 years were 60.2 and 69.6%, respectively. Univariate analyses demonstrated that the Residual Disease in Breast and Nodes (RDBN) index was the most significant prognostic factor for OS (p = 0.0082) and DFS (p = 0.0022), and multivariate analyses mainly revealed that the residual tumor size, residual involved node number and post-chemotherapy Scarff-Bloom-Richardson (SBR) grading were the most significant prognostic factors. Conclusions: In a cohort of patients who were all homogeneously treated with some of the most common drugs for breast cancer, we demonstrate that NACT may provide additional prognostic factors and confirm the RDBN index. As this index allows for the prediction of survival with different breast cancer subtypes, we suggest that it should be calculated routinely to help clinicians to select patients who need adjuvant treatments.

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Section: Discussionsupporting

confidence: 76%

Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease

et al. 2015

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“…The adoption of neoadjuvant chemotherapy in the treatment of breast cancer has had a significant influence on trends in mastectomy and reconstruction over time, partly because it increases the possibility of breast‐conserving surgery in patients who were previously candidates for mastectomy or were considered inoperable44. Although high overall, the rate of reconstruction at this institution started to decline towards the end of the study period34.…”

Section: Discussionmentioning

confidence: 99%

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

et al. 2017

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BackgroundBreast reconstruction is an important component of multidisciplinary breast cancer management. The practice of breast reconstruction after mastectomy has evolved significantly in the past decade as a result of both increasing mastectomy rates and advances in reconstructive strategy. These changes have significantly influenced the contemporary surgical management of breast cancer. The aim of this study was to examine trends in breast reconstruction after mastectomy in an Irish population.MethodsData were reviewed from a database of all patients who had mastectomy with or without breast reconstruction at Galway University Hospital, a tertiary breast cancer referral centre, between 2004 and 2014. Trends in breast reconstruction after mastectomy were explored with respect to patient demographics, clinicopathological features, and neoadjuvant and adjuvant therapy.ResultsOf 1303 patients who underwent mastectomy during interval studied, 706 (54.2 per cent) had breast reconstruction after mastectomy. In 629 patients (89·1 per cent), breast reconstruction was performed in the immediate setting. Reconstruction rates increased over time from 20·5 per cent in 2004 to 44·7 per cent in 2014. Reconstruction was more commonly performed in younger patients and those with benign, in situ and early‐stage disease. A negative relationship between radiotherapy and reconstruction was observed. A pedicled flap with or without an implant was the most commonly used reconstructive approach in patients receiving radiotherapy.ConclusionBreast reconstruction after mastectomy has become the standard of care in the surgical treatment of breast cancer. Recent trends show a transition favouring implant‐based approaches.

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“…First, it was a retrospective study and there may be bias in the analysis of the data. Second, the local recurrence rate was low and the follow-up of some studies [22,29] was very short. This may have been a reason why these studies failed to reveal a difference in local recurrence rates between groups.…”

Section: Discussionmentioning

confidence: 99%

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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Oncologic safety of breast‐conserving surgery compared to mastectomy in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer

Abstract: BCS after NCT is a safe option for LABC that responded well to NCT. Shrinking tumors with NCT allows more opportunities to apply BCS without compromising outcomes.

Cited by 69 publications

References 25 publications

Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease

Prognostic Factors in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy: Towards a Quantification of Residual Disease

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

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

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