Clinical Course of Breast Cancer Patients With Complete Pathologic Primary Tumor and Axillary Lymph Node Response to Doxorubicin-Based Neoadjuvant Chemotherapy

Kuerer, Henry Mark; Newman, Lisa A.; Smith, Terry L.; Ames, F. C.; Hunt, Kelly K.; Dhingra, Kapil; Theriault, Richard L.; Singh, Gurpreet; Binkley, Susan M.; Sneige, Nour; Buchholz, Thomas A.; Ross, Merrick I.; McNeese, Marsha D.; Buzdar, Aman U.; Hortobágyi, Gabriel N.; Singletary, S. Eva

doi:10.1200/jco.1999.17.2.460

Cited by 1,214 publications

(801 citation statements)

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“…Another publication with a large number of patients treated in two prospective randomised trials utilised the classification system proposed by Kuerer et al (1999). This has three grades; no evidence of residual disease, o1 cm 3 of macroscopic residual tumour (residual microscopic foci of cancer cells included) and 41 cm 3 of residual macroscopic tumour (Kuerer et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

“…This has three grades; no evidence of residual disease, o1 cm 3 of macroscopic residual tumour (residual microscopic foci of cancer cells included) and 41 cm 3 of residual macroscopic tumour (Kuerer et al, 1998). These investigators analysed 372 patients with locally advanced breast cancer treated with four cycles of neoadjuvant chemotherapy in two prospective randomised studies (Kuerer et al, 1999). Of these patients, 43 (12%) had no histological evidence of residual invasive carcinoma in both breast and axillary nodes.…”

Section: Discussionmentioning

confidence: 99%

“…Women achieving no residual histological evidence of tumour after chemotherapy at the time of surgery (i.e. a pathological complete response (pCR)) have a significantly improved survival (Bonadonna et al, 1998;Fisher et al, 1998;Kuerer et al, 1999), and pCR is often used as an early surrogate marker of treatment efficacy. However, there is no standard method for grading pathological response of breast tumours to neoadjuvant chemotherapy and a number of different classification systems have been proposed (Chevallier et al, 1993;Sataloff et al, 1995;Fisher et al, 1997;Honkoop et al, 1998;Kuerer et al, 1998;Ogston et al, 2003).…”

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“…For instance in NSABP B18, the largest randomised trial, 88 out 682 patients (13%) were classified as having no residual invasive disease following neoadjuvant chemotherapy (Wolmark et al, 2001). Similarly, in another large group of patients, treated within two prospective randomised trials, 43 of 372 patients (12%) were recorded as achieving a pCR (Kuerer et al, 1999). Thus, with a relatively small proportion of patients achieving a pCR following neoadjuvant chemotherapy, any comparison between those with residual DCIS and no invasive or in situ disease will inevitably involve small numbers of patients.…”

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Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

et al. 2006

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Patients who have no residual invasive cancer following neoadjuvant chemotherapy for breast carcinoma have a better overall survival than those with residual disease. Many classification systems assessing pathological response to neoadjuvant chemotherapy include residual ductal carcinoma in situ (DCIS) only in the definition of pathological complete response. The purpose of this study was to investigate whether patients with residual DCIS only have the same prognosis as those with no residual invasive or in situ disease. A retrospective analysis of a prospectively maintained database identified 435 patients, who received neoadjuvant chemotherapy for operable breast cancer between February 1985 and February 2003. Of these, 30 (7%; 95% CI 5 -9%) had no residual invasive disease or DCIS and 20 (5%; CI 3 -7%) had residual DCIS only. With a median follow-up of 61 months, there was no statistical difference in disease-free survival, 80% (95% CI 60 -90%) in those with no residual invasive or in situ disease and 61% (95% CI 35 -80%) in those with DCIS only (P ¼ 0.4). No significant difference in 5-year overall survival was observed, 93% (95% CI 75 -98%) in those with no residual invasive or in situ disease and 82% (95% CI 52 -94%) in those with DCIS only (P ¼ 0.3). Due to the small number of patients and limited number of events in each group, it is not possible to draw definitive conclusions from this study. Further analyses of other databases are required to confirm our finding of no difference in disease-free and overall survival between patients with residual DCIS and those with no invasive or in situ disease following neoadjuvant chemotherapy for breast cancer.

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confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

et al. 2006

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“…Nearly all neoadjuvant chemotherapy trials demonstrated that survival was correlated with the response to neoadjuvant chemotherapy with survival rates ranging from 85% to 90% for patients with complete breast tumor and lymph node response. 3,33,34 Conversely, patients with no response displayed poor survival. It could be hypothesized that with the regimens of chemotherapy used in the historical randomized trials, two populations can be individualized, namely, one population best treated with preoperative chemotherapy and one best treated with adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Breast‐conserving surgery after neoadjuvant anthracycline‐based chemotherapy for large breast tumors

Rouzier

Mathieu

Sidéris

et al. 2004

Cancer

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BACKGROUNDRandomized trials comparing neoadjuvant versus adjuvant chemotherapy show that primary chemotherapy allows more frequent breast‐preserving surgery even though no survival advantage has been demonstrated. The aim of the current study was to determine the predicting factors and the survival impact of breast conservation in patients with large breast tumors treated with neoadjuvant chemotherapy.METHODSBetween January 1987 and December 2001, 594 patients with invasive T2–3 breast carcinoma who were ineligible for breast‐conserving surgery (the mean initial tumor diameter was 49 mm) were treated with 3 or 4 courses of an anthracycline‐based primary chemotherapy, surgery, and radiotherapy. Various clinicopathologic factors were tested as possible predicting factors of breast‐preserving surgery. Survival analyses were performed to determine the implications of breast‐conserving surgery on outcome.RESULTSAfter primary chemotherapy, 287 (48%) patients were eligible for breast‐conserving surgery and 307 patients underwent a mastectomy. Initial tumor diameter > 5 cm, low histologic grade, lobular histology, and multicentricity were independent predicting factors of breast conservation ineligibility in the multivariate analysis (logistic regression). In the univariate survival analysis, a failure of breast‐preserving surgery was associated with a poor outcome. Local disease recurrence‐free survival rates were similar in patients treated with lumpectomy and mastectomy.CONCLUSIONSThe results reported in the current study suggested that initial diameter, histologic type and grade, and multicentricity are potential prechemotherapy predicting factors of breast conservation. When carefully selected, patients treated with breast conservation had a risk of local disease recurrence similar to the risk of chest wall disease recurrence after mastectomy. Cancer 2004. © 2004 American Cancer Society.

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Breast Sentinel Lymph Node Dissection Before Preoperative Chemotherapy

et al. 2008

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Clinical Course of Breast Cancer Patients With Complete Pathologic Primary Tumor and Axillary Lymph Node Response to Doxorubicin-Based Neoadjuvant Chemotherapy

Cited by 1,214 publications

References 31 publications

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

Breast‐conserving surgery after neoadjuvant anthracycline‐based chemotherapy for large breast tumors

Breast Sentinel Lymph Node Dissection Before Preoperative Chemotherapy

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