Breast-Conserving Surgery After Tumor Downstaging by Neoadjuvant Chemotherapy is Oncologically Safe for Stage III Breast Cancer Patients

e11532 Background: Neoadjuvant chemotherapy (NCT) is a reasonable option for operable breast cancer in terms of downsizing large tumor and increasing the rate of breast-conserving surgery (BCS). However, BCS in patients with large breast tumors down-staged by NCT remains still controversial because of the possibility of residual tumor and resistance to NCT. Aims of this study were to evaluate the long-term survival results of patients who received NCT and BCS compared to patients who received BCS first and to compare recurrence and survival rates between patients who received preplanned BCS and those who received down-staged BCS among patients who underwent NCT. Methods: Between 2000 and 2007, 70 patients with clinical stage III breast cancer who received BCS after NCT (NCT group) and 72 patients with clinical stage III breast cancer who underwent BCS first (Surgery group) were retrospectively reviewed. Among 70 patients received NCT, 45 patients (64.3%) received preplanned BCS (preplanned BCS group) and 25 patients (35.7%) received down-staged BCS (down-staged BCS group). The long-term results including ipsilateral breast tumor recurrence (IBTR), locoregional recurrence (LRR), disease recurrence and survival rates were compared with groups. Results: There was no significant difference in IBTR-free survival, LRR-free survival rates, disease-free survival and overall survival rates between the NCT and the Surgery group (p=0.971, p=0.294, p=0.863 and p=0.933, respectively). Among patients who received NCT, IBTR-free survival, LRR-free survival, disease-free survival and overall survival rates was not also different between the preplanned BCS group and the down-staged BCS group (p=0.278, p=0.501, p=0.776 and p=0.412, respectively). Conclusions: Our study demonstrated that patients who received BCS after NCT showed similar long-term resutls compared to patients who received BCS first in clinical stage III breast cancer patients. Also, down-staged BCS shows is oncologically as safe as preplanned BCS in clinical stage III breast cancer patients in terms of recurrence and survival.

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SYSTEMATIC REVIEW AND METAANALYSIS OF THE RESULTS OF BREAST-CONSERVING SURGERY AFTER NEOADJUVANT CHEMOTHERAPY IN BREAST CANCER PATIENTS

Siberian Journal of Oncology ◽

10.21294/1814-4861-2021-20-2-118-126 ◽

2021 ◽

Vol 20 (2) ◽

pp. 118-126

Author(s):

A. R. Bosieva ◽

M. V. Ermoshchenkova ◽

A. D. Zikiryakhodzhayev ◽

N. N. Volchenko

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Breast Tissue ◽

Breast Conserving Surgery ◽

Resection Margins ◽

Breast Cancer Patients ◽

Inclusion Criteria ◽

Positive Resection Margins ◽

Cosmetic Outcomes

Background. Neoadjuvant chemotherapy (NACT) is a standard of care for locally advanced breast cancer patients. One of the main advantages of NACT is the reduction of the tumor size and regression of lymph node metastasis.The aim of the study was to analyze the outcomes of breast-conserving surgery after NACT compared to adjuvant chemotherapy, including the examination of the width of resection margins and the frequency of re-operations, the volume of tissue removed and cosmetic outcomes.Material and Methods. We analyzed 1219 publications available from pubMed, Medline, Cochrane Library, 1057 of them did not meet the inclusion criteria, 162 publications were selected to cover all the following inclusion criteria: surgical margin status, frequency of re-operations, volume of tissue removed and cosmetic outcomes. Finally, 22 studies met fully specified criteria.Results. Studies included in this review demonstrated a different frequency of positive resection margins (2–39.8 %), reoperations (0–45.4 %), the volume of tissue removed (43.2–268 cm3), and the weight of the resected breast tissue (26.4–233 grams) after NACT. Conclusion. The data obtained showed a decrease in the frequency of positive resection margins and re-operations in patients who received NACT compared to patients who did not receive NACT (5–39.8 % versus 13.1–46 % and 0–45.4 % versus 0–76.5 %, respectively), as well as a decrease in the amount of the removed breast tissue without the negative effect on the frequency of resection margins, thus allowing minimization of the extent of surgery and improvement of cosmetic outcomes.

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COMPARATIVE EFFECTIVENESS OF BREAST CONSERVING SURGERY VERSUS MASTECTOMY ON SURVIVAL IN BREAST CANCER PATIENTS THAT RECEIVED NEOADJUVANT CHEMOTHERAPY AND POST-OPERATIVE RADIATION THERAPY

10.29289/259453942019v29s1g07 ◽

2019 ◽

Author(s):

Gustavo Nader Marta ◽

◽

Allan A. Lima Pereira ◽

Leandro Jonata Oliveira ◽

José Roberto Filassi ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Comparative Effectiveness ◽

Breast Conserving Surgery ◽

Breast Cancer Patients

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Prognostic significance of bcl-2 expression in stage III breast cancer patients who received doxorubicin and cyclophosphamide followed by paclitaxel as adjuvant chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.670 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 670-670 ◽

Cited By ~ 1

Author(s):

K. Lee ◽

B. Kim ◽

S. Lee ◽

W. Han ◽

D. Kim ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Prognostic Factor ◽

Cancer Patients ◽

Prognostic Significance ◽

Stage Iii ◽

Breast Cancer Patients ◽

Stage Iii Breast Cancer ◽

Erbb2 Overexpression ◽

Er Expression

670 Background: Bcl-2 is an anti-apoptotic marker and regulated by hormonal receptor pathways in breast cancer. We performed this study to assess the prognostic significance of ER, PR, p53, c-erbB2, bcl-2, Ki-67, and EGFR as a marker for relapse in breast cancer patients who received same adjuvant therapy in a single institution. Methods: A cohort of 154 curatively resected breast cancer patients who had 4 lymph nodes or more and received doxorubicin and cyclophosphamide followed by paclitaxel (AC/T) as adjuvant chemotherapy was analyzed for clinicopathologic characteristics including disease-free survival (DFS). Patients with ER and/or PR expression received 5 years of tamoxifen following AC/T. The markers were analyzed by immunohistochemistry. Results: Median f/u duration was 25 months and 32 patients (20.8%) had recurrences. Stage (IIIa vs. IIIc) affected recurrences significantly, however, types of surgery, histology, histologic grade, presence of endolymphatic emboli, or close resection margin did not. Among the immunohistochemical markers, bcl-2 expression was the only one to be associated significantly with prolonged DFS (median 54 mo in bcl-2 (−) vs. not reached in bcl-2 (+); p=0.016). Furthermore, bcl-2 was an independent prognostic factor for DFS in multivariate analysis. Bcl-2 expression was significantly correlated with ER expression (p<0.001), and inversely correlated with c-erbB2 overexpression (p=0.027). Patients with both ER and bcl-2 expression had a longer DFS compared to the other patients (not reached vs. 54 mo, p=0.019). Patients with bcl-2 expression had a significantly longer DFS even in ER (+) subgroups (not reached vs 54 mo; p=0.011). Patients with c-erbB2 overexpression, ER (−) and bcl-2 (−) had a shorter DFS than the others (38 mo vs. not reached; p=0.029). Conclusions: In our homogenous patient cohort, bcl-2 expression was correlated with ER expression, and inversely correlated with c-erbB2 overexpression. Bcl-2 was an independent prognostic factor for DFS in curatively resected stage III breast cancer patients. No significant financial relationships to disclose.

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Sixteen years follow-up results of a randomized phase II trial of neoadjuvant FAC compared with CMF in stage III breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1073 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1073-1073

Author(s):

Ariel Osvaldo Zwenger ◽

Julieta Leone ◽

Carlos Teodoro Vallejo ◽

Juan Eduardo Perez ◽

Alberto Omar Romero ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Phase Ii ◽

Breast Conserving Surgery ◽

Stage Iii ◽

Long Term Results ◽

Significant Difference ◽

Stage Iii Breast Cancer

1073 Background: Neoadjuvant chemotherapy allows direct evaluation of the tumor’s sensitivity to therapy, eradication of micrometastatic disease and the possibility of performing breast conserving surgery. The aim of this study was to describe long-term results of neoadjuvant chemotherapy in stage III breast cancer patients (pts). Methods: We evaluated 126 pts with stage III breast cancer that participated in a phase-II randomized trial of neoadjuvant 5-fluorouracil, doxorubicin and cyclophosphamide (FAC every 21 days) compared with cyclophosphamide, methotrexate and 5-fluorouracil (CMF days 1 and 8 every 28). Chemotherapy was administered for three cycles prior to definitive surgery and radiotherapy, and then for six cycles as adjuvant. Response was assessed by WHO criteria. Results: Pts characteristics were well balanced in both groups (FAC: 64pts, CMF: 62pts). Median follow-up was 4.5 years (range 0.2-16.4). No significant difference was found regarding acute and long-term toxicity; however, alopecia was more frequent in FAC group. Breast conserving surgery was performed in 13.5% of pts with no difference between groups. Objective response rate (OR) was similar in both groups but pathological complete response was achieved by 4 pts who received FAC. Although both groups had similar locoregional and distant recurrences, contralateral breast cancer was higher in the CMF group (6.5% vs 1.6%, P=NS). Disease free survival (DFS) and overall survival (OS) data are shown in the table. After 16 years of follow-up, 42.1% (n=53) of pts are still alive. Disease progression was the principal cause of death in both groups (78.9% vs 84.2%). Conclusions: To the best of our knowledge, this is the first study to report long-term outcomes of FAC and CMF in the neoadjuvant setting. Within the sensitivity of our study, both regimens showed similar OR, long-term toxicity, DFS and OS rate at 16 years. Around 40% of pts are currently alive. Clinical trial information: NCT00002696. [Table: see text]

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