scholarly journals Re-Excision Rates in Breast-Conserving Surgery for Invasive Breast Cancer after Neoadjuvant Chemotherapy with and without the Use of a Radiopaque Tissue Transfer and X-ray System

Breast Care ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 302-307
Author(s):  
Suniza Jamaris ◽  
Leyla Akpolat-Basci ◽  
Miltiades Stephanou ◽  
Sarah Wetzig ◽  
Yueksel Cubuk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Invasive Breast Cancer ◽  
Breast Conserving Surgery ◽  
Control Group ◽  
Study Group ◽  
Transfer System ◽  
Tissue Transfer ◽  
Resected Tissue ◽  
Specimen Radiography

Background: Significant re-excision rates in breast-conserving surgery (BCS) after neoadjuvant systemic chemotherapy may result from difficulties in defining the surgical target particularly in cases with excellent treatment response. Devices allowing an exact topographic localisation of the lesion in the resected tissue could reduce re-excision rates by optimising the intraoperative detection of involved margins. Methods: 80 patients with invasive breast cancer receiving BCS after neoadjuvant chemotherapy were included in this non-randomized case-control study. 40 patients with specimen radiography performed in a standard approach (control group) were compared to 40 patients with use of a radiopaque tissue transfer system (study group). Results: 19/80 (23.75%) patients required re-excision because of involved margins; among those, 14/40 (35%) were in the control group and 5/40 (12.5%) in the study group. The association between the use of the radiopaque tissue transfer system and the lower re-excision rate was statistically significant (p = 0.023). Conclusion: Our analysis provides a rationale for the routine use of a radiopaque tissue transfer system for specimen radiography in BCS after neoadjuvant chemotherapy for invasive breast cancer in order to reduce re-excision rates.

scholarly journals Alteration in Steroid Hormone and HER2/neu Receptor Status Following Neoadjuvant Chemotherapy in Triple Negative Breast Cancer. Is There Any Hope?

2021 ◽  
Author(s):  
Rama Das ◽  
Parna Basu ◽  
Suman Ghosh ◽  
Debasish Guha
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Hormone Receptor ◽  
Triple Negative ◽  
Control Group ◽  
Study Group ◽  
Residual Tumour ◽  
Receptor Status ◽  
Platinum Based Chemotherapy

Introduction: Breast cancer continues to be the most common cancers among women in India. The Triple Negative Breast Cancer (TNBC) is a heterogeneous group of malignancy which is often aggressive and has a worse prognosis. Aim: The aim of this study was to assess the hormone receptor and HER2/neu status with platinum based chemotherapy in TNBC. Materials and Methods: The study was analysed retrospectively in a tertiary care centre of West Bengal from Januay 2017 to December 2019. Forty TNBC patients of Locally Advanced Breast Cancer (LABC) cases who received carboplatin along with neoadjuvant chemotherapy (study group) were compared with other group of 64 TNBC patients (control group) who did not receive any chemotherapy making a total of 104 cases of TNBC patients who were selected for the study. All the patients in both the groups had modified radical mastectomy. The study group of 40 TNBC patients who received chemotherapy also showed pathological partial response. Masterchart was prepared comprising patient’s age, menopausal status, family history, therapy history, histo-morphological features, hormone receptor and HER2/neu status after platinum added chemotherapy. Oestrogen Receptor (ER)/Progesterone Receptor (PR) were considered positive, if >1% tumour cell nuclei were immunoreactive and negative, if it was otherwise. HER-2/neu score of 3+ was taken as positive by Immunohistochemistry (IHC) method. Statistical analysis for descriptive purposes, percentages and mean were calculated. Comparison of both the groups was done by Pearson’s Chi-squared and Fisher’s-exact test. Significance level was considered at p-value <0.05. Results: TNBC patients (NACT group) showed hormone receptor positivity of 21 cases (52.50%) after chemotherapy along with carboplatin. HER2/neu positivity was detected in 9 (22.5%) cases. Non-NACT (64) cases were considered as control group for comparison. The effect of NACT in TNBC patients was found to be statistically significant with respect to change in HER2/neu (p=0.033, p<0.05) and ER status (p<0.05) while change in PR status was found to be statistically insignificant. Conclusion: The study showed significant alteration in hormonal and HER2/neu receptor status in TNBC patients receiving platinum added neoadjuvant chemotherapy. This study found statistical significance and justifies re-evaluation of these Hormone Receptor (HR) and HER2/neu markers in residual tumour after chemotherapy.

Does Conventional Specimen Radiography After Neoadjuvant Chemotherapy of Breast Cancer Help To Reduce The Rate of Second Surgeries?

2021 ◽  
Author(s):  
Benedikt Schaefgen ◽  
Annika Funk ◽  
Peter Sinn ◽  
Thomas Bruckner ◽  
Christina Gomez Andreu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
False Negative ◽  
Positive Margin ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Target Lesion ◽  
Number Needed To Treat ◽  
Positive Margins ◽  
Specimen Radiography

Abstract PurposeThis is the first study to systematically evaluate the diagnostic accuracy of intraoperative specimen radiography on margin level and its potential to reduce second surgeries in patients treated with neoadjuvant chemotherapy. MethodsThis retrospective study included 174 cases receiving breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. Conventional specimen radiography (CSR) was performed to assess potential margin infiltration of the target lesion and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. A subgroup analysis was performed for patients with and without clinical complete response. Results 1044 margins were assessed. Of 47 (4.5%) histopathological positive margins, CSR identified 9 correctly (true positive). 38 infiltrated margins were missed (false negative). This resulted in a sensitivity of 19.2%, a specificity of 89.2%, a PPV of 7.7% and a NPV of 95.9%. The rate of secondary procedures was reduced from 23 to 16 with a number needed to treat (NNT) of CSR guided intraoperative re-excisions of 25. In the subgroup of patients with cCR, the prevalence of positive margins was 10/510 (2.0%), PPV was 1.9% and the NNT was 85. ConclusionPositive margins after NACT are rare and CSR has only a low sensitivity to detect them. Thus, the rate of secondary surgeries cannot be significantly reduced by recommending targeted re-excisions, especially in cases with cCR.

The effects of complete decongestive therapy on the extent of secondary lymphoedema in women after breast cancer treatment

Physiotherapy ◽  
2015 ◽  
Vol 23 (1) ◽  
Author(s):  
Iwona Malicka ◽  
Dawid Marciniak
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Breast Conserving Surgery ◽  
Breast Cancer Treatment ◽  
Post Treatment ◽  
Control Group ◽  
Study Group ◽  
Complete Decongestive Therapy ◽  
The Mean ◽  
Decongestive Therapy

AbstractAim of the study was to assess the effects of Complete Decongestive Therapy (CDT) on the extent of lymphedema of the upper extremity in women post cancer treatment.Study group: 20 women after breast cancer treatment with a mean age of 63.15 years (± 8.15). The group was intentionally divided into 2 groups: patients with lymphedema and patients without lymphedema. The first group (study group, n = 10) consisted of women who received CDT. 70% of them had undergone mastectomy and 30% – breast-conserving surgery. In addition, 60% had received radiotherapy, 70% – chemotherapy and 80% – hormone therapy. The mean post-treatment period was 6.2 ± 3.5 years. Patients in the second group (control group, n = 10) did not receive any anti-edema treatments. 90% of them had undergone mastectomy and 10% – breast-conserving surgery. In addition, 40% of study participants had received adjuvant treatment in the form of radiotherapy, 80% – chemotherapy and 50% – hormone therapy. The mean post-treatment period was 6.3 ± 4.4 years. Method: The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software.A significant reduction in the extent of lymphedema (p = 0.005) was achieved in the CDT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.33).Complete decongestive therapy is an effective method of treatment of lymphedema in women post breast cancer treatment.

scholarly journals Clinical curative effect of neoadjuvant chemotherapy combined with immunotherapy and its impact on immunological function and the expression of ER, PR, HER-2 & SATB1 in HER-2-Positive breast cancer patients

2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Zhi Chen ◽  
Mei-xiang Sang ◽  
Cui-zhi Geng ◽  
Wei Hao ◽  
Hui-qun Jia
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Control Group ◽  
Study Group ◽  
Immunological Function ◽  
Breast Cancer Patients ◽  
Curative Effect ◽  
Her 2 ◽  
Positive Breast Cancer

Objective: To evaluate the clinical curative effect of neoadjuvant chemotherapy combined with immunotherapy and its impact on immunological function and the expression of ER, PR, HER-2 and SATB1 in HER-2-positive breast cancer patients. Methods: The subjects of study were 80 patients with HER-2-positive breast cancer. Enrolled patients were randomly divided into two groups, with 40 cases in each group at The Fourth Affiliated Hospital of Hebei Medical University from March 2018 from March 2021. Patients in the control group were provided with neoadjuvant chemotherapy using TAC regimen merely; while those in the study group received oral administration of Apatinib Mesylate (500mg/d; three weeks a cycle) on the basis of the TAC regimen. Further comparative analysis was performed focusing on the therapeutic effect and adverse drug reaction rate of the two groups; levels of CD3+, CD4+, CD8+ and CD4+/CD8+ of T lymphocyte subsets in the two groups before and after treatment; as well as the expressions of ER, PR, HER-2 and SATB1 in the two groups before and after treatment. Results: The total response rate was 77.5% and 55% in the study group and the control group, respectively, with an obviously better outcome in the former group than that in the latter group (p=0.03). Meanwhile, the incidence of adverse reactions was 40% in the study group and 45% in the control group, without statistical difference (p=0.65). There were statistically significant differences that the levels of CD3+, CD4+, and CD4+/CD8+ in the study group were significantly higher when compared with those in the control group after treatment (CD3+, p=0.00; CD4+, p=0.02; CD4+/CD8+, p=0.00); while no evident change was observed in the level of CD8+ (p=0.88). After treatment, the positive expression rates of ER, HER-2 and SATB1 were remarkably lower in the study group than those in the control group, showing statistically significant differences (ER, HER-2, p=0.03; SATB1, p=0.02). However, there was no statistically significant difference in the positive expression rate of PR between the study group and the control group (P=0.80). Conclusions: Neoadjuvant chemotherapy combined with immunotherapy has significant effect on the treatment of HER-2-positive breast cancer patients. It can result in the significant enhancement of T lymphocyte function, obvious improvement in the negative converse rates of ER, HER-2 and SATB1, and no evident increase in the adverse drug reactions. The proposed therapeutic approach is safe, effective, and have certain clinical value. doi: https://doi.org/10.12669/pjms.38.3.5199 How to cite this:Chen Z, Sang M, Geng C, Hao W, Jia H. Clinical curative effect of neoadjuvant chemotherapy combined with immunotherapy and its impact on immunological function and the expression of ER, PR, HER-2 and SATB1 in HER-2-Positive breast cancer patients. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5199 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Efficacy of Combining Metformin with Neoadjuvant Chemotherapy on Pathologic Response in Non-diabetic Patients with Carcinoma Breast- A Randomized Controlled Trial

2021 ◽  
pp. 1-7
Author(s):  
Kadambari Dharanipragada ◽  
Niraj Ghimire ◽  
Kadambari Dharanipragada ◽  
Nisha Ghimire ◽  
Shanmugam Dasarathan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Progressive Disease ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Pathologic Response ◽  
Control Group ◽  
Study Group ◽  
Breast Cancer Patients ◽  
Metformin Group

Background: In India breast cancer forms the commonest malignancy after cervical cancer in females and is detected in 20 per 1,00,000 women. Metformin acts as oral hypoglycemia drug and anti-tumor drug. Mechanism of action of metformin is to inhibit cellular proliferation as well as to increases pathological Complete Response in breast cancer patients when used in addition to neoadjuvant chemotherapy. Methods: This randomized control trial study was conducted on 54 patients to assess the effect of adding metformin to neoadjuvant chemotherapy in pathologic response in Breast Cancer patients as well as to establish safety and tolerance of metformin as a neoadjuvant drug in Breast cancer and to measure the effect of metformin on sex hormones, tumor and insulin resistance dated from November 2016 to June 2018. Study group received metformin along with neoadjuvant chemotherapy and Control group received neoadjuvant chemotherapy only. In every visit, side effects of metformin were assessed like nausea, vomiting, abdominal discomfort, dizziness. Pre NACT-BMI and Post NACT- BMI were calculated and differences were assessed. Any post-operative complication was looked for post-surgery. Data was analysed by SPSS version 19. Results: Our study showed that DHEAS level decreased by 5.65 in study group while the fall in DHEAS in non-metformin arm was 2.1. 7.1% of participants in metformin group showed complete response, 78.6% participants showed partial response and 14.3% had progressive disease. In non-metformin group, complete, partial response and progressive disease were seen in 40.0%, 60.0% and 0.0% respectively. Patient in control group had higher complete response. However, the difference in pathologic complete response between metformin and non-metformin group has no statistical significance (p= 0.057). Conclusion: Our study supports the view that patient without insulin resistance treated with NACT alone has higher pathologic complete response than the patient treated with NACT with metformin. However, sample size of present study is small to support the results.

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