Breast-conserving treatment after neoadjuvant chemotherapy in large breast cancer

Inaji, Hideo; Komoike, Yoshifumi; Motomura, Kazuyoshi; Kasugai, Tsutomu; Sawai, Yugo; Koizumi, Masahiko; Nose, Takayuki; Koyama, Hiroki

doi:10.1007/bf02967542

Cited by 10 publications

(4 citation statements)

References 23 publications

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“…This study was approved by our institutional review board. Shorter follow‐up results were reported previously (8). All patients were diagnosed as having invasive carcinoma by core needle biopsy before chemotherapy.…”

Section: Methodssupporting

confidence: 54%

Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsilateral Breast Tumor Recurrence

et al. 2010

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n Abstract: Neo-adjuvant chemotherapy enables us to increase the possibility of breast-conserving surgery for large, bulky tumors. However, several studies have reported that ipsilateral breast tumor recurrences (IBTRs) occur more frequently after neo-adjuvant chemotherapy than originally envisaged. Recently, it was demonstrated that clinical early response after neo-adjuvant chemotherapy predicts pathological complete response. In this study, we assessed the association of clinical early response after neo-adjuvant chemotherapy with successful breast-conserving surgery and IBTR risk. Between 1995 and 2002, 114 patients with T 3.1-6 cm, N 0 or 1, M 0 breast cancer who were candidates for mastectomy but desired breast-conserving surgery were treated with neo-adjuvant chemotherapy. After two cycles of anthracyclinebased neo-adjuvant chemotherapy and before surgery, breast tumors were measured by palpation or ultrasound. Clinical response after two cycles of chemotherapy was defined as positive when the largest tumor dimension was reduced by 30% or greater. Median follow-up time was 72 months. After two cycles of neo-adjuvant chemotherapy, 54 (47.4%) of 114 patients achieved an early response. Patients with the early response underwent breast-conserving surgery significantly more frequently than those without the early response (78% versus 58%, p = 0.03). In addition, the early response was significantly correlated with selection of breast-conserving surgery (odds ratio 3.8, p = 0.01) after adjustments for various clinicopathological factors. Patients without the early response showed significantly lower 6-year IBTR-free survival than patients with the early response (75% versus 97%, p = 0.02). In addition, patients with the early response showed significantly higher 6-year disease-free survival rates than those with the early response (p = 0.02). Multivariate analysis showed that the early response was a predictive factor of IBTR-free survival, being independent of other clinicopathological factors. In conclusion, the early response to neo-adjuvant chemotherapy may be a useful predictor of both selection of surgical method and IBTR risk. n Key Words: breast cancer, early response, ipsilateral breast tumor recurrence, neo-adjuvant chemotherapy N eo-adjuvant chemotherapy is increasingly used in the management of operable breast cancer patients with large tumors with the expectation of breast-conserving surgery. Also, neo-adjuvant chemotherapy increases the possibility of breast-conserving surgery without decreasing the long-term outcome (1). However, recent meta-analysis has reported high local recurrence rates in patients who underwent breastconserving surgery after neo-adjuvant chemotherapy (2). Therefore, it is quite important to identify the predictive factors of breast conservation eligibility and the risk of ipsilateral breast tumor recurrences (IBTR) as early as possible in order to minimize the adverse events of neo-adjuvant chemotherapy for non-responders. However, few data are available concerning whether b...

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Section: Methodssupporting

confidence: 54%

Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsilateral Breast Tumor Recurrence

et al. 2010

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“…However, the pathological effect was 5% of pCR, which was rather low. Next, the increase in breast conservation by downstaging, which is one of the objectives of pre-operative chemotherapy, made conservative surgery possible for 27 patients (66%) with tumor diame- [12][13][14]. This result demonstrates that ET therapy can adequately meet the objectives of pre-operative chemotherapy.…”

Section: Discussionmentioning

confidence: 88%

Changes in biological markers, particularly hormone receptors, due to pre-operative chemotherapy (epirubicin/docetaxel) in operable breast cancer

Tashima

Nishimura

2008

Oncol Rev

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“…Younger group Elder group χ 2 P breast-conserving surgery after the stage was lowered with neo-adjuvant chemotherapy [7][8][9] . In this cohort of the patients, 9 cases received neo-adjuvant chemotherapy followed by breast-conserving surgery.…”

Section: Characteristicsmentioning

confidence: 99%

The mid-long term outcome of breast-conserving patients with different ages

Zhang

Wang

Zhang

2009

Clin. Oncol. Cancer Res.

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OBJECTIVE Breast-conserving surgery has been a standard treatment for relatively small size of breast cancer. Younger breast cancer patients have more desire to conserve their breasts. This study was to investigate the clinicopathological characteristics and prognosis of younger breast cancer patients who received breastconserving treatment in China. METHODS The data of 232 breast cancer patients who received breast-conserving treatment in Cancer Hospital of Chinese Academy of Medical Science from January 1 st , 1999 to December 31 st , 2005, were collected and retrospectively analyzed. According to the age, the patients were divided into 2 groups: younger group (age ≤ 35 at the time of diagnosis) and elder group (age > 35). The clinical features of the patients in the 2 groups were compared, and their clinical characteristics, recurrence, metastasis and survival status were summarized. RESULTS In the 232 cases, younger patients accounted for 15.9% (37/232), the elder 84.1% (195/232). By December 2008, the median time of follow-up was 54 months (ranging from 2 months to 118 months). Two patients (5.41%, 2/37) in the younger group and 5 patients (2.56%, 5/195) in the elder group died. The 5-year overall survival rate (OS) in the younger and elder groups was 96.08% and 97.19%, respectively (χ 2 = 0.69, P = 0.4066). Local recurrence (LR) or distant metastasis (DM) presented in 5 patients (5/37, 13.51%) in younger group. LR or DM presented in 10 patients (10/195, 5.13%) in elder group. The 5-year disease-free survival (DFS) rate in the younger and elder groups was 82.58% and 95.52%, respectively (χ 2 = 4.02, P = 0.0451). Lymph node status and the age of 35 years old or younger were the prognosis factors aff ecting the DFS of patients who received breast-conserving treatment (OR = 3.467, 95%CI: 1.048-11.472, P < 0.05; OR = 0.245, 95%CI: 0.069-0.863, P < 0.05). Lymph node status was the only prognostic factor affecting the DFS of younger group patients (OR = 7.357, 95%CI: 1.030-52.563, P < 0.05). CONCLUSION Though the younger and elder patients have the same mid-long term survival rate, younger patients are more likely to have recurrence or metastasis than the elder patients. Breast-conserving surgery given to the younger patients especially to the younger patients with lymph nodes positive should be contemplated cautiously.

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Breast-conserving treatment after neoadjuvant chemotherapy in large breast cancer

Cited by 10 publications

References 23 publications

Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsilateral Breast Tumor Recurrence

Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsilateral Breast Tumor Recurrence

Changes in biological markers, particularly hormone receptors, due to pre-operative chemotherapy (epirubicin/docetaxel) in operable breast cancer

The mid-long term outcome of breast-conserving patients with different ages

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