Preoperative Chemotherapy for Operable Breast Cancer Improves Surgical Outcomes in the Community Hospital Setting

Komenaka, Ian K.; Hibbard, Michael L.; Hsu, Chiu Hsieh; Low, Boo Ghee; Salganick, Jason A.; Bouton, Marcia E.; Jha, Chandra Bhushan

doi:10.1634/theoncologist.2010-0268

Cited by 19 publications

(14 citation statements)

References 31 publications

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“…Excision volumes in patients undergoing BCS after NACT were reported in fifteen studies, including two prospective cohort studies and thirteen retrospective studies [ 20 , 25 , 27 , 28 , 31 , 33 , 39 , 40 , 42 , 44 , 45 , 47 , 48 – 50 ]. Thirteen studies were single-center studies.…”

Section: Resultsmentioning

confidence: 99%

“…In patients with T2 or T3 tumors, the mean excision volume was significantly lower in patients who received chemotherapy preoperatively (113 cm 3 vs. 213 cm 3 , p = 0.0043) with no difference in tumor size at presentation [ 25 ]. Four retrospective studies that compared BCS with or without NACT reported conflicting results [ 27 , 28 , 31 , 33 ]. Two studies showed lower excision volumes after NACT (132.2 cm 3 vs. 158.1 cm 3 , p = 0.04 and 143.6 cm 3 vs. 273.9 cm 3 , p < 0.004) [ 27 , 28 ], whereas one study showed larger excision volumes following NACT (108 cm 3 vs. 78 cm 3 , p = 0.002) [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Four retrospective studies that compared BCS with or without NACT reported conflicting results [ 27 , 28 , 31 , 33 ]. Two studies showed lower excision volumes after NACT (132.2 cm 3 vs. 158.1 cm 3 , p = 0.04 and 143.6 cm 3 vs. 273.9 cm 3 , p < 0.004) [ 27 , 28 ], whereas one study showed larger excision volumes following NACT (108 cm 3 vs. 78 cm 3 , p = 0.002) [ 31 ]. In a national pathology database study from the Netherlands, no difference was found between the use or absence of NACT in BCS (50 cm 3 vs. 46 cm 3 , p = 0.14) [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…It is important to realize that larger volumes do not necessarily result in fewer involved margins or less additional therapy. [ 16 , 25 , 27 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

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Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes

Volders

Negenborn

Spronk

et al. 2017

Breast Cancer Res Treat

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PurposeNeoadjuvant chemotherapy (NACT) is increasingly used in breast cancer treatment. One of the main goals of NACT is to reduce the extent of local surgery of the breast and axilla. The aim of this study was to determine surgical outcomes for patients receiving breast-conserving therapy (BCT) after NACT, including margin status plus secondary surgeries, excision volumes, and cosmetic outcomes.MethodsA systematic review was performed in accordance with PRISMA principles. Pubmed, MEDLINE, Embase, and the Cochrane Library were searched for studies investigating the results of BCT following NACT. The main study outcomes were margin status, additional local therapies, excision volumes, and cosmetic outcomes. Non-comparative studies on NACT were also included. Exclusion criteria were studies with less than 25 patients, and studies excluding secondary mastectomy patients.FindingsOf the 1219 studies screened, 26 studies were deemed eligible for analysis, including data from 5379 patients treated with NACT and 10,110 patients treated without NACT. Included studies showed wide ranges of tumor-involved margins (2–39.8%), secondary surgeries (0–45.4%), and excision volumes (43.2–268 cm3) or specimen weight (26.4–233 g) after NACT. Most studies were retrospective, with a high heterogeneity and a high risk of bias. Cosmetic outcomes after NACT were reported in two single-center cohort studies. Both studies showed acceptable cosmetic outcomes.InterpretationThere is currently insufficient evidence to suggest that NACT improves surgical outcomes of BCT. It is imperative that clinical trials include patient outcome measures in order to allow monitoring and meaningful comparison of treatment outcomes in breast cancer.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…It is important to realize that larger volumes do not necessarily result in fewer involved margins or less additional therapy. [ 16 , 25 , 27 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

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Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes

Volders

Negenborn

Spronk

et al. 2017

Breast Cancer Res Treat

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“…a taxa de margem limítrofe ou positiva foi reduzida à metade (23% versus 46%, p=0,04) e isso resultou em menos reexcisões (p=0,01). o volume de tecido removido também foi menor no grupo com quimioterapia neoadjuvante (143,6 cm 3 contra 273,9 cm 3 , p=0,003) 8 . esses autores também demonstraram que a aderência ("compliance") ao tratamento foi maior no grupo tratado com quimioterapia neoadjuvante versus adjuvante (100% versus 70%, p=0,0001) 9 .…”

Section: Resultsunclassified

Quimioterapia Neoadjuvante no Câncer de Mama Operável: Revisão da Literatura

Costa

Chagas²

2013

Rev. Bras. Cancerol.

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Introdução: A quimioterapia neoadjuvante foi inicialmente utilizada no tratamento sistêmico do câncer de mama localmente avançado e inoperável. Com a base adquirida nessa proposta terapêutica, passou-se a realizar o tratamento neoadjuvante em pacientes com tumores operáveis, e uma ampla experiência se acumula nessa indicação. Objetivos: Realizar uma análise crítica da literatura publicada sobre a quimioterapia neoadjuvante ou primária, priorizando sua indicação no tratamento câncer de mama operável. Método: Os dados da revisão foram identificados através de artigos publicados entre 1997 a 2012, tendo como ferramenta o PubMed/MedLine (www.ncbi.nlm.nih.gov/ pubmed), utilizando as palavras-chave: “neoadjuvant therapy”, “primary systemic therapy”, “breast neoplasms” e “operable breast cancer”. Resultados: Foram encontrados na literatura médica, 1.043 ensaios clínicos e utilizados 25 deles nesta revisão (estudos prospectivos, metanálise e análise de coortes). Conclusão: Após a análise, pode-se concluir que, no câncer de mama operável, a quimioterapia neoadjuvante oferece resultados de sobrevida equivalentes aos obtidos com quimioterapia adjuvante, permitindo aumento do percentual de cirurgias conservadoras, melhora dos desfechos cirúrgicos e adequada avaliação do prognóstico. Os esquemas de tratamento mais estabelecidos empregam antraciclinas, taxanes e, quando indicado, terapia biológica. No campo experimental, seu uso contribui como base para o rápido desenvolvimento de tratamentos melhores e mais eficazes do câncer de mama.

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Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery

Woeste

Bhutiani

Donaldson

et al. 2020

Journal of Surgical Oncology

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BackgroundNeoadjuvant chemotherapy (NAC) increases breast‐conserving surgery (BCS) rates with comparable locoregional control and survival outcomes to adjuvant therapy. More women are receiving NAC and achieving pathologic complete responses (pCR). This study sought to evaluate the effect of NAC on surgical outcomes after the adoption of a “no‐ink‐on‐tumor” margin policy in patients undergoing primary BCS (PBSC).MethodsAn IRB approved database was queried for women undergoing BCS for invasive breast cancer after March 2014. We compared patients who underwent NAC followed by BCS versus PBCS. Demographic, tumor, treatment, and outcome variables were compared using both univariate and multivariable analysis.ResultsA total of 162 patients were evaluated. NAC patients had significantly lower re‐excision rates (0% NAC vs. 9% PBCS, p = .03), margin positivity (0% NAC vs. 5% PBCS, p = .01), and greater patient satisfaction with breast cosmesis (97 NAC vs. 77 PBCS, p = .01). On multivariable analysis, NAC was not an independent predictor of lower final resection volume, total complications, or greater satisfaction with breasts when controlling for age and T category at diagnosis.ConclusionNAC followed by BCS may offer less margin positivity, lower re‐excision rates, and greater patient satisfaction when compared to a contemporary PBCS cohort in the “no‐ink‐on‐tumor” era.

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Preoperative Chemotherapy for Operable Breast Cancer Improves Surgical Outcomes in the Community Hospital Setting

Abstract: Results. There were 212 patients included. Seventynine percent of patients who underwent PC had a clini-

Cited by 19 publications

References 31 publications

Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes

Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes

Quimioterapia Neoadjuvante no Câncer de Mama Operável: Revisão da Literatura

Evaluating the effect of neoadjuvant chemotherapy on surgical outcomes after breast conserving surgery

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