scholarly journals Clinical efficacy of neoadjuvant FAC chemotherapy in locally advanced breast cancer patients

2003 ◽  
Vol 11 (3) ◽  
pp. 148-148
Author(s):  
Zdravko Zdrale ◽  
Snezana Susnjar ◽  
Ljiljana Stamatovic ◽  
Miodrag Matijasevic ◽  
Zora Neskovic-Konstantinovic
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Surgical Treatment ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Fac Chemotherapy

Background: FAC chemotherapy (CT) regimen is a well-established standard in the neo-adjuvant or primary chemotherapy for locally advanced breast cancer (LABC) treatment. Its main goal is to achieve locoregional tumor shrinkage allowing for the radical surgical treatment with curative intent. Concerning that prognosis of these patients depends on the response to initial neo-adjuvant therapy, we have analyzed clinical response to standard FAC CT in a group of routinely treated unrespectable LABC patients. Methods: During the three-year period, 50 pre- and postmenopausal patients without any cardiac risk factors, aged from 38-61 years, were treated with 3 to 4 cycles of neo-adjuvant FAC CT (500-50-500 mg/m 2 /21d). The initial diagnosis of LABC was based on tumor, nodal and/or skin characteristics: in 25 patients tumor was classified as T3-T4, N2 category was registered in 28 patients while skin lymphagiosis was found in 22 patients. Pathological diagnosis was confirmed either by skin, tumor and/or lymph node biopsy, or by tumorectomy (in 45 and 5 patients, respectively). Steroid receptor status was determined by biochemical DCC method in 35, or by immunohistochemistry in 7 patients. Results: Axillary lymph node status was evaluable in 47/50, and T status in 48/50 patients. Objective nodal response was achieved in 41/47 patients (12 CR and 29 PR, respectively), inflammatory skin features responded in 17/22 patients (2CR and 15PR, respectively). Overall objective response was achieved in 41/48 (82%) patients (9 CR, 32 PR), while 5 patients were classified as SD, and 2 consecutive patients as PD, with 2 non-evaluable patients. As far as toxicity was concerned, no acute cardiac damage was noted, emesis was successfully prevented with standard anti-emetics, and grade 3 to 4 alopecia developed in most of patients. Hematological tolerance was also good. Conclusion: Our results confirmed the high response rate to standard neoadjuvant FAC CT in unresectable LABC patients, in whom downstaging was achieved in majority, allowing for radical surgical treatment.

scholarly journals Level of education, background and clinical stage as prognostic factors according RMST function in patients with early and locally advanced breast cancer: a single institution experience from Romania

2021 ◽  
Author(s):  
Irina Niță ◽  
Cornelia Nițipir ◽  
Ștefania Andreea Toma ◽  
Alexandra Maria Limbău ◽  
Edvina Pirvu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Advanced Breast Cancer ◽  
Tumor Size ◽  
Locally Advanced Breast Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Lymph Node Status ◽  
Level Of Education

Background and aims. Our aim is to examine the relationship between the level of education, background, tumor size and lymph node status on the treatment outcome in a group of patients with early and locally advanced breast cancer (BC) by using the restricted mean survival time (RMST), which summarizes treatment effects in terms of event-free time over a fixed period of time. Methods. We evaluated the prognostic values in 143 patients treated for early BC at Elias University Emergency Hospital, Bucharest, Romania and followed up for a maximum of 36 months. The protocol was amended to include the levels of education (gymnasium, high school, or university), the background (urban or rural) and the clinical stage (primary tumor (T) and regional nodes (N)). The methodology consisted in using a Kaplan–Meier analysis and RMST for the entire sample and Cox regression, for the variables with statistical influence. The principal endpoints of the study were overall survival (OS) and progression free survival (PFS). Results. The level of education had impact both on RMST OS (35.30 vs. 26.70) and death HR (hazard ratio) in the group of patients with general school level, compared with those with graduated university. In this study, the urban or rural background did not impact the outcome, probably because in this study we included predominantly patients from urban areas (83%). Although clinical tumor size measurements did not impact the outcome, the clinical staged lymph node influenced both OS (p=0.0500) and PFS (p=0.0006) for the patients with palpable or imaging proof of lymph node involvement of station 2 or 3. Conclusions. RMST provides an intuitive and explicit way to express the effect of those risk factors on OS and PFS in a cohort of early breast cancer patients. Low level of education and high-grade clinical lymph node status negatively influences the outcome of this cohort of BC patients.

Evaluation of FDG PET in early axillary lymph node response to neoadjuvant chemotherapy in locally advanced breast cancer patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10500-10500
Author(s):  
C. Rousseau ◽  
C. Bodet-Milin ◽  
J. Bennouna ◽  
L. Ferrer ◽  
L. Campion ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Advanced Breast Cancer ◽  
Fdg Pet ◽  
Axillary Lymph Node ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Axillary Lymph ◽  
Breast Cancer Patients

10500 Background: Regional axillary lymph node status has remained the single most independent variable to predict prognosis both in terms of disease recurrence and survival. This study aimed to prospectively assess sequential FDG PET findings as early predictors of axillary lymph node response to neoadjuvant chemotherapy in locally advanced breast cancer patients. Methods: A total of 255 attenuation-corrected scans were obtained from 51 patients. Images were acquired with a PET/CT scanner (GE Discovery LS) following administration of FDG (5 MBq/kg) at baseline, and after the first, second, third, and sixth course of chemotherapy. Clinical examination and US were used to assess the size of axillary lymph nodes. PET data were interpreted using standardized uptake values (SUV) corrected or not for partial volume effects. Changes in the SUV were considered as surgical/histopathological responses. Results: This study focused on axillary lymph node staging, therefore, primary breast tumor data were not considered in the analysis. The sensitivity, specificity, and accuracy of axillary node staging was higher with PET (75%, 87%, 80%) than with clinical examination and US (50%, 78%, 63%, and 50%, 83%, and 65%, respectively), and even the more so when PET images were corrected for partial volume effects (86%, 83%, 84%). Significant differences between absolute FDG uptake values in responders and non-responders were observed at baseline (p < 0.05). While FDG uptake did not vary much in non-reponders, as confirmed by histopathology, it markedly decreased to baseline levels in responders (p < 10−5). Fifty percent of baseline SUV was considered the best cut-off value to distinguish responders from non-responders. The sensitivity, specificity, negative predictive value, and accuracy of FDG PET after one course of chemotherapy were respectively, 96%, 75%, 95%, and 84%. Tumor response assessment by clinical examination or US was never statistically significant whatever the cut-off. Conclusions: The pathological status of regional axillary lymph nodes in locally advanced breast cancer patients can be accurately predicted after one course of neoadjuvant chemotherapy based on FDG PET images. No significant financial relationships to disclose.

Use of seed i125 in the surgical treatment of locally advanced breast cancer with affection of contralateral axillary adenopathy.

2021 ◽  
Vol 32 (2) ◽  
pp. 168-170
Author(s):  
A García Reyes ◽  
P Fernández Zamora ◽  
M López-Cantarero García-Cervantes ◽  
F Del Río Lafuente ◽  
F Oliva Mompean
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Cáncer De Mama ◽  
Quimioterapia Neoadyuvante

Resumen El cáncer de mama localmente avanzado supone una entidad poco frecuente que requiere de un abordaje multidisciplinar. La quimioterapia neoadyuvante supone el tratamiento inicial fundamental, seguido de un tratamiento quirúrgico que suele conllevar una mastectomía, estando en debate el rescate axilar. Presentamos el caso de una paciente con cáncer de mama derecha localmente avanzado con afectación axilar derecha y afectación de un ganglio axilar contralateral, a la que el marcaje de la axila contralateral con una semilla de I125 y la demostración de respuesta axilar patológica completa, permitió la realización de BSGC de la axila izquierda, evitando una linfadenectomia axilar.

scholarly journals Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer

2017 ◽  
Vol 44 (6) ◽  
pp. 612-618
Author(s):  
PAULO HENRIQUE WALTER DE AGUIAR ◽  
RANNIERE GURGEL FURTADO DE AQUINO ◽  
MAYARA MAIA ALVES ◽  
JULIO MARCUS SOUSA CORREIA ◽  
AYANE LAYNE DE SOUSA OLIVEIRA ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Sentinel Lymph Nodes ◽  
Advanced Breast ◽  
Identification Rate

ABSTRACT Objective: to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. Methods: clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. Results: identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. Conclusion: autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

Concurrent chemoradiotherapy (CRT) following neoadjuvant chemotherapy (NACT) in locally advanced breast cancer (LABC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11063-11063
Author(s):  
A. Alvarado-Miranda ◽  
R. Morales-Barrera ◽  
O. Arrieta ◽  
J. Zinser-Sierra ◽  
A. Gamboa-Vignole ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Advanced Breast Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Advanced Breast ◽  
Axillary Lymph ◽  
Main Determinant

11063 Background: Despite broad advances in the treatment of LABC, 30 to 40% of patients responding to NACT develop locoregional relapse. We performed a retrospective analysis of the experience obtained so far in patients with LABC who were treated with CRT after NACT in terms of pathologic complete response (pCR), relapse-free survival (RFS) and overall survival (OS) at our institution. Methods: One hundred and twelve patients with LABC (Stage IIB-IIIB) were treated between January 2000 and December 2003 with NACT with 5FU 500mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 500mg/m2 (FAC) or doxorubicin 50 mg/m2 and cyclophosphamide 500mg/m2 (AC) administered i.v. in four 21-day cycles. CRT with 60 Gy whole-breast irradiation and concurrent weekly mitomycin 5mg, 5FU 500mg and dexamethasone 16 mg or cisplatin 30 mg, gemcitabine 100 mg and dexamethasone 16 mg. Subsequently they underwent surgery and 6 to 8 weeks later received 2 additional courses of FAC, AC or paclitaxel 90mg weekly for 12 weeks and in estrogen receptor (ER) positive patients hormone therapy. Results: Median tumor size 5 cm; stages IIB, IIIA and IIIB were 21.4%, 42.9% and 35.7% respectively. pCR was 42% (CI 95% 33.2 - 50.5) in breast and 29.5% (CI 95% 21.4 - 37.5) in breast and axillary lymph nodes. Multivariate analysis showed the main determinant of pCR was negative ER (P 0.016). Median RFS has not been reached. The 5 year RFS is 76.9% (CI 95% 68.2 - 84.7). No relationship between pCR and RFS was found. Multivariate analysis showed the main determinant of RFS was the clinical stage (p=0.03). Only one patient had local recurrence. The 5 year OS is 84.2% (CI 95% 75 - 93.2). Toxicity during CRT: grade 1–2 neutropenia 32.2%, grade 1–2 anemia 5.2%, grade 3 radioepithelitis 22.4% Conclusions: This modality has good locoregional control for locally advanced breast cancer with an acceptable toxicity profile. Futher investigation of concurrent chemoradiotherapy should be explored in LABC. No significant financial relationships to disclose.

scholarly journals The peculiarities of surgical service of locally advanced breast cancer after neoadjuvant systemic treatment

2015 ◽  
Vol 22 (3) ◽  
pp. 42-47
Author(s):  
O. L. Petrenko
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Advanced Breast Cancer ◽  
Systemic Treatment ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Conservative Surgery ◽  
Advanced Breast ◽  
Treatment Stage

Patients with locally advanced (T2-4N0-3M0) breast cancer, receiving neoadjuvant systemic treatment with the following application of surgical treatment stage (radical mastectomy or conservative surgery) were selected from the data base. The data of the first cancer register in the Russian Federation, disposing the data base for more than 5000 patients with breast cancer were analyzed in this work. Consistent with the primary goal of the work the information about 286 patients with locally advanced breast cancer (clinical stages IIB-IIB), receiving neoadjuvant systemic treatment with the following application of surgical treatment stage (radical mastectomy or conservative surgery), was obtained from the date base. The follow up period is from 2 to 10 years. The estimation of application efficiency of neoadjuvant chemotherapy, hormonal treatment and target therapy was done. The basic clinical, pathomorphological and biological factors (HER2, ER, PR, degree of malignancy), decisive for planning of relevant neoadjuvant treatment, enabling to customize medical disposal for a patient and contributing to the increase of comprehensive treatment, rising of general and relapse free survival of patients with locally advanced breast cancer, who underwent breast-conserving surgeries.

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