High expression of post-treatment Ki-67 status is a risk factor for locoregional recurrence following breast-conserving surgery after neoadjuvant chemotherapy

e12625 Background: Pathologic complete response(pCR) after neoadjuvant chemotherapy(NAC) in patients with breast cancer(BC) is associated with decreased recurrence and improved survival. In NSABP B18 and B27, 10-yr locoregional recurrence(LRR) after pCR in patients with Stage I-III BC undergoing breast conserving surgery(BCS) and whole breast RT(WBRT) was 5.2-6.9%. However, LRR may be overestimated as Her2 therapy was not used and only some eligible patients received endocrine therapy. A retrospective study using modern protocols found a 5-yr LRR of up to 2.6%. We hypothesize that LRR in N0 patients is even lower, and de-escalation of therapy should be examined. The study objective is to assess if a prospective trial of omission of WBRT after BCS in patients with N0 BC and pCR after NAC is warranted and to assess feasibility. Methods: Patients with T1-T3 N0 invasive BC diagnosed between Dec 2011-2017 treated with NAC and BCS were identified from a hospital BC registry. Health records were retrospectively reviewed to identify patients with pCR, defined as absence of residual invasive or in-situ disease(ypT0N0). Incidents of locoregional and distant recurrence were recorded. Results: Of 89 patients with T1-3 N0 invasive BC treated with NAC and BCS, 29(32.6%) had pCR. Median follow-up was 61.1 months. Median age was 55 yrs and median tumour size was 2.4cm. Receptor status was 16(55.2%) HR-Her2-, 4(13.8%) HR-Her2+, 7(24.1%) HR+Her2+ and 2(6.9%) HR+Her2-. NAC protocols consisted of an anthracycline and/or a taxane in 27(90%) patients, and 6 patients were treated on NAC trials. All patients with Her2+ disease received Her2 targeted therapy. Adjuvant endocrine therapy was taken by 8 of 9 patients with HR+ disease. All patients received WBRT without nodal RT. RT plan was available for 26(86.7%) patients. RT dose ranged from 40-50Gy, and all but 4 received tumour bed boost. There were no local or regional recurrence events at last follow-up. One patient developed brain metastases at 15.7 months. Conclusions: Over 6 years, 29 patients were identified that would be eligible for a prospective trial evaluating omission of WBRT after pCR in N0 patients treated with NAC and BCS. At median 5-yr follow-up, there were no locoregional recurrences in our cohort, demonstrating that the absolute benefit provided by WBRT is likely small. Our results indicate a prospective trial is warranted and will require multi-institution participation to accrue.

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Patterns of Relapse Related to High Expression of Ki-67 After Neoadjuvant Chemotherapy in Triple Negative Breast Cancer

Journal of Gynecology and Obstetrics ◽

10.11648/j.jgo.20210905.11 ◽

2021 ◽

Vol 9 (5) ◽

pp. 139

Author(s):

Gines Hernandez-Cortes ◽

Javier Hornedo ◽

Raquel Murillo ◽

Ricardo Sainz De La Cuesta ◽

Lucia Gonzalez-Cortijo

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

High Expression ◽

Ki 67

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The impact of pattern of tumor response and other post-treatment histologic features on local recurrence in patients treated with neoadjuvant chemotherapy and breast conservation.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.581 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 581-581

Author(s):

Alison Laws ◽

Ricardo G. Pastorello ◽

Jungeon Choi ◽

Olga Kantor ◽

Samantha Grossmith ◽

...

Keyword(s):

Local Recurrence ◽

Neoadjuvant Chemotherapy ◽

Treatment Effect ◽

Tumor Response ◽

Residual Disease ◽

Breast Conserving Surgery ◽

Invasive Disease ◽

Post Treatment ◽

The Impact

581 Background: Residual disease after neoadjuvant chemotherapy (NAC) is a poor prognostic factor. The relationship between the pattern of tumor response and other post-treatment histologic features on local recurrence (LR) is not well studied. Methods: We identified 380 patients (pts) treated with NAC, breast-conserving surgery and radiation from 2002-2014. Pts with available surgical slides underwent detailed pathology review. Pathologic complete response (pCR) was defined as no invasive or in situ disease in the breast or axilla. Pattern of tumor response was defined as: none, scattered, or concentric. The degree of treatment effect was categorized as: absent, mild or marked. Univariate (UVA) and multivariate analyses (MVA) were performed to identify factors associated with LR. Results: 243 (64%) cases had complete slides available and formed the study cohort. 76 (31%) were ER+/HER2-, 90 (38%) ER-/HER2- and 77 (31%) HER2+. 98% of HER2+ pts received neoadjuvant trastuzumab; 89% of ER+ pts received adjuvant endocrine therapy. At median follow-up of 75 months, 10/243 (4.1%) pts had LR and 5-yr LR-free survival was 95.7%. LR occurred in 1/76 (1.3%) pts with breast pCR, 1/19 (5.2%) with residual DCIS, and 8/148 (5.4%) with residual invasive disease; including 6/78 (7.7%) with scattered tumor response, 2/46 (4.3%) with concentric response and 0/24 with no response. On UVA, age (OR < 50 vs ≥50 5.9, p = 0.03) and residual DCIS with comedonecrosis (OR 8.2, p < 0.01) were significantly associated with LR. Presence of tumor bed at the margin (OR 4.6, p = 0.06) approached significance. The odds of LR were higher with scattered regression (OR 1.83 vs. concentric, p = 0.47) and lower with breast pCR (OR 0.23, p = 0.17), but these results were not statistically significant. Multicentric disease, receptor status, ypT, ypN, RCB score, degree of treatment effect, high-grade residual invasive disease, margin status of residual disease and lymphovascular invasion were not associated with LR (all p > 0.05). Age (OR < 50 vs ≥50 7.4, p = 0.04) and residual DCIS with comedonecrosis (OR 7.5, p = 0.02) remained significant on MVA. Conclusions: With modern systemic therapy, LR rates after NAC, breast-conserving surgery and radiation are low, with less than 5% of patients experiencing a LR after a median follow-up of over 6 years. Young age and residual DCIS with comedonecrosis were associated with LR, but not pattern of tumor response.

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A nomogram for predicting locoregional recurrence in primary breast cancer patients who received breast-conserving surgery after neoadjuvant chemotherapy

Journal of Surgical Oncology ◽

10.1002/jso.23586 ◽

2014 ◽

Vol 109 (8) ◽

pp. 764-769 ◽

Cited By ~ 15

Author(s):

Naoko Matsuda ◽

Naoki Hayashi ◽

Sachiko Ohde ◽

Hiroshi Yagata ◽

Yuka Kajiura ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Primary Breast Cancer ◽

Locoregional Recurrence ◽

Breast Conserving Surgery ◽

Breast Cancer Patients

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Evaluation of locoregional recurrence in patients with early breast carcinoma post-breast-conserving surgery with and without the use of preoperative chemotherapy

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i2.2087 ◽

2020 ◽

Vol 11 (2) ◽

pp. 1824-1830

Author(s):

Samer Makki Mohamed Al-Hakkak ◽

Saad Ab-razq Mijbas ◽

Noor Abdulmunem Salman Al-Bdiri ◽

Hassan Abdulla Abadi AL-Aquli

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Breast Carcinoma ◽

Neoadjuvant Chemotherapy ◽

Locoregional Recurrence ◽

Locally Advanced ◽

Breast Conserving Surgery ◽

Resected Specimen ◽

P Value ◽

Early Breast Carcinoma

The effects of neoadjuvant chemotherapy in increasing the rate of conservative breast therapy and associated with reducing morbidity and better cosmetic has been fully acknowledged. Now, there are commonly used neoadjuvant chemotherapy for operable early breast carcinomas patients. Currently, neoadjuvant chemotherapy is used for locally advanced breast carcinoma, inflammatory breast cancer, and down staging of the large tumor to allow for breast conservative therapy. A prospective study performed in the department of surgery in Al-Sadder Medical City/Najaf city/Iraq, from the …….. of October 2015 to the 1st of October 2018, where 48 patients presented with a breast cancer diagnosis by clinical examination, Mammography, breast ultrasound, chest x-ray, bone scan, serum CEA, CA15_3 level, the initial diagnosis of breast cancer made by core needle biopsy. Breast saving surgery consisted of wide local excision with a safe margin with standard level I, II lymph node of axilla dissection. The resected specimen and lymph node was sent for histopathological examination; the size, width, length &height dimension were recorded and the resection margin was recorded positive if close to 2mm and negative if >2mm tumor-free margin. The 48 patients enrolled in this study with a mean age at diagnosis of 44.6 ± 8.4 years. 34 patients received neoadjuvant chemotherapy, Locoregional recurrence reported in 4 patients (28.6%) not received neoadjuvant chemotherapy (P. value < 0.001), the higher relapse rate was reported significantly in the cases aged more than 50 years compared to those aged 50 years or below (P. value = 0.05, significant). Neoadjuvant chemotherapy decreases the incidence of locoregional recurrence of early breast carcinoma after breast-conserving surgery.

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