Patterns of Local and Distant Disease Relapse in Patients with Breast Cancer Treated with Primary Chemotherapy: Do Patients with a Complete Pathological Response Differ from Those with Residual Tumour in the Breast?

Abstract

This study aimed to evaluate patterns of local and distant disease recurrence in patients having primary chemotherapy and compared patterns of relapse in patients with a complete pathological response with those who had residual breast disease. This is an observational study using a sequential series of patients treated with primary chemotherapy. They were followed up for a minimum of 5 years. All data was collected prospectively. Three hundred forty-one consecutive patients with breast cancer were treated with up to eight cycles of doxorubicin-based chemotherapy. Clinical and pathological response rates were evaluated and patients were followed up for disease recurrence (local and distant) and overall survival. Fifty-two patients (16.5%) had a complete pathological response to chemotherapy. Distant disease recurrence occurred in nine patients (17.3%) but no local recurrence was observed. In patients not having a complete pathological response, 86 patients (32.6%) subsequently developed metastases. Local recurrence of disease occurred in 12 (4.5%). There was a statistically significant difference in overall survival between patients whose tumours had a complete pathological response compared with patients who had residual disease in the breast following chemotherapy (88% versus 70% at 5 years, p = 0.036). Following primary chemotherapy, about 84% of patients had residual disease in the breast. Surgery is necessary to ensure complete removal of residual tumour and excellent rates of local control are achievable. A complete pathological response is associated with fewer local and distant recurrences as well as improved survival although there are no differences in time to development of metastatic relapse.

Dose-Dense Primary Chemotherapy, as Part of Multidisciplinary Treatment, for Inoperable Stage III B Breast Cancer – Long-Term Results of a Phase II Trial

“…The excellent long-term local and distant control achieved in this patient allow us to maintain hope for women to preserve their breast even with locally advanced disease. Several authors have reported unacceptably high local-regional and ipsilateral breast tumor recurrence rates and poorer OS in LABC patients, not primarily eligible for conservative treatment, who underwent BCT after primary chemotherapy (LRR rate up to 28%) [12, 13], suggesting some differences between de novo BCT and BCT following primary chemotherapy.In contrast to these reports, other studies reported satisfactory local (≤5%) and distant control in LABC downstaged with primary chemotherapy [12, 14, 15], by adopting careful patient selection, as for patients with early breast cancer treated by breast conservation without initial primary chemotherapy. In our study, overall BCT patients had a clinical response >50%, residual tumor size ≤3 cm as a solitary lesion, negative resection margins and resolution of skin and/or chest wall involvement and radiation.…”

“…breast-conserving therapy (BCT), remains a great challenge for both oncologists and surgeons [9,10,11,12] because of concerns about unacceptably high local failure rates reported by several studies [12, 13]. In contrast to these reports, other studies reported satisfactory local and distant control in LABC downstaged with primary chemotherapy [12, 14, 15]. In summary, local-regional relapse (LRR) rates ranged from 1 to 28% [12], but most studies included small numbers of patients with T4 disease, together with other LABC, such as T2 and T3 or any T-N 2–3 , thus making interpretation of the data difficult.…”

Functional Imaging Using Diffuse Optical Spectroscopy of Neoadjuvant Chemotherapy Response in Women with Locally Advanced Breast Cancer

“…The emerging standard treatment for LABC involves multimodality treatment with neoadjuvant chemotherapy. Although there is no evidence to suggest that there is a survival benefit of neoadjuvant chemotherapy when compared with adjuvant treatment, some studies have shown an overall survival benefit for those patients who achieve a pathologic complete response after neoadjuvant chemotherapy compared with patients without a complete response (6)(7)(8)(9)(10)(11). An advantage of neoadjuvant chemotherapy is that it decreases tumor bulk and may allow breast-conserving therapy.…”

MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy

“…2 There was a statistically significant correlation between pathologically complete response and both overall survival and disease-free survival. [4][5][6][7][8] Therefore, for patients who are receiving NAC, pCR is the most relevant prognostic factor.…”