Can we predict local recurrence in breast conserving surgery after neoadjuvant chemotherapy?

Cebrecos, Isaac; Córdoba, Octavi; Deu, J.; Xercavins, Jordi; Rubio, Isabel T.

doi:10.1016/j.ejso.2010.04.004

Cited by 23 publications

(17 citation statements)

References 28 publications

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“…In the present study, two types of tumor regression were observed by MRI after NAC for the breast cancer patients . The results showed that 44.3% of tumors had concentric shrinkage while 55.7% were nests/had dendritic shrinkage, which is consistent with the results of Takeda et al .…”

Section: Discussionsupporting

confidence: 92%

Magnetic resonance imaging patterns of tumor regression in breast cancer patients after neo-adjuvant chemotherapy, and an analysis of the influencing factors

Shao

et al. 2017

Breast J

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The objective of this study was to analyze the patterns of breast tumor shrinkage in patients after neo-adjuvant chemotherapy (NAC) based on magnetic resonance imaging (MRI), and to evaluate the influential factors. Preoperative breast dynamic contrast-enhanced MRI was performed on 88 patients before NAC, every 2 weeks during their chemotherapy treatment, and the week before their surgery. The MRI enhancement pattern of the primary tumors was classified into one of four categories based on BI-RADS-MRI: type I (postcontrast mass image), II (multiple small masses image), III (postcontrast mass image with peripheral non-mass enhancement image), and IV (nonmass enhancement image). Multivariate regression and χ test analyses were employed to establish significant associations. Two kinds of tumor regression patterns were observed: concentric shrinkage was observed in 39 lesions of 88 patients (44.3%), and nests or dendritic shrinkage was observed for the other 49 lesions (55.7%). ER+/HER2-, HER2+, and type I lesions were observed in 23 (62.2%), 21 (63.6%), and 29 (60.0%) patients, respectively, out of 49 nest or dendritic shrinkage pattern lesions. Triple negative breast cancer lesions, and type II, III, and IV lesions were observed in 13 (72.2%), 9 (81.8%), 10 (62.5%), and 10 (76.9%) patients, respectively, out of 39 lesions with a concentric shrinkage pattern. Molecular subtypes (χ =7.171, P<.05) and the MRI schedule of enhancement (χ =11.244, P<.05) were significantly associated with the tumor regression patterns. Multivariate analysis showed molecular subtypes (P<.05) and MRI pattern enhancement (P<.05) were significant predictive factors. Molecular subtypes and the MRI enhancement patterns of the primary tumors were significant predictive factors for tumor regression patterns of breast cancer after NAC.

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Section: Discussionsupporting

confidence: 92%

Magnetic resonance imaging patterns of tumor regression in breast cancer patients after neo-adjuvant chemotherapy, and an analysis of the influencing factors

Shao

et al. 2017

Breast J

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“…Although ipsilateral thoracic wall events involving the sternal bone were defined as a distant event in 2014 31, previous studies with long follow-up period did not specify this form of recurrence 32. In the present study, we observed 2 patients with simultaneous IBTR and sternal infiltration, but 1 patient underwent local full-thickness chest wall resection.…”

Section: Discussionmentioning

confidence: 45%

Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

Carrara¹,

Scapulatempo‐Neto²,

Abrahão-Machado³

et al. 2017

Clinics

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OBJECTIVE:To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer.METHODS:A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival.RESULTS:Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01).CONCLUSIONS:Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.

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“…Advanced tumor size at diagnosis was also found to be an independent risk of recurrence by other authors [16,21]. In addition, a trend between LVI and LR was demonstrated but lacked statistical significance [16].…”

Section: Predictors Of Local Recurrencementioning

confidence: 94%

“…He concluded that residual tumor diameter >2 cm after NACT, positive axillary lymph node, multifocal residual disease, and lympho-vascular invasion (LVI) were strongly correlated with risk for LR [23]. Advanced tumor size at diagnosis was also found to be an independent risk of recurrence by other authors [16,21]. In addition, a trend between LVI and LR was demonstrated but lacked statistical significance [16].…”

Section: Predictors Of Local Recurrencementioning

confidence: 94%

Surgical Considerations Following Preoperative Systemic Chemotherapy

Sbaity

Jacobs

2011

Curr Breast Cancer Rep

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The indications of neoadjuvant chemotherapy for breast cancer are extending to a larger population of breast cancer patients. The aims of this therapy are to transform the cancer to an operable form, downsize the tumor volume to allow a lumpectomy instead of a mastectomy, or to perform an in vivo test of the effect of the treatment on breast cancer in a specific individual. Along with these benefits, there is concern about the safety of lumpectomy and sentinel lymph node biopsy after neoadjuvant chemotherapy. In this review, we discuss the experience of breast conservation therapy after neoadjuvant chemotherapy and the reported recurrence rates in the preserved breasts. An overview of the studies that utilized sentinel lymph node biopsy after neoadjuvant chemotherapy is presented, summarizing the identification rates and false-negative rate.

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Can we predict local recurrence in breast conserving surgery after neoadjuvant chemotherapy?

Cited by 23 publications

References 28 publications

Magnetic resonance imaging patterns of tumor regression in breast cancer patients after neo-adjuvant chemotherapy, and an analysis of the influencing factors

Magnetic resonance imaging patterns of tumor regression in breast cancer patients after neo-adjuvant chemotherapy, and an analysis of the influencing factors

Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

Surgical Considerations Following Preoperative Systemic Chemotherapy

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