Multimodal treatment of locoregionally advanced breast cancer

Hortobágyi, Gabriel N.; Blumenschein, George R.; Spanos, William J.; Montague, Eleanor D.; Buzdar, Aman U.; Yap, H. Y.; Schell, Frank C.

doi:10.1002/1097-0142(19830301)51:5<763::aid-cncr2820510502>3.0.co;2-c

Cited by 225 publications

(70 citation statements)

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“…A pCR in the breast and axilla can be obtained in up to 33% of the cases, as a function of treatment used, in operable breast cancer (Hortobagyi et al, 1983;Lippman et al, 1986;Scholl et al, 1994;Schwartz et al, 1994;Powles et al, 1995;Brain et al, 1997;Bonadonna et al, 1998;Fisher et al, 1998;Morrell et al, 1998;Kuerer et al, 1999). It is known that neoadjuvant chemotherapy is able to convert clinically involved lymph nodes to a pathologically negative status in 25 -38% of breast tumours.…”

Section: Discussionmentioning

confidence: 99%

“…There are multiple aspects regarding this treatment modality that have not been sufficiently elucidated (De Lena et al, 1978;Hortobagyi et al, 1983;Lippman et al, 1986;Scholl et al, 1994;Fisher et al, 1997Fisher et al, , 1998. The clinical response to neoadjuvant chemotherapy, which is commonly reported, does not always accurately reflect the pathological response: residual tumour is frequent in clinically complete responses, and conversely some complete pathological responses are found in good partial clinical responses.…”

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confidence: 99%

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Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

et al. 2002

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Only a few papers have been published concerning the incidence and outcome of patients with a pathological complete response after cytotoxic treatment in breast cancer. The purpose of this retrospective study was to assess the outcome of patients found to have a pathological complete response in both the breast and axillary lymph nodes after neoadjuvant chemotherapy for operable breast cancer. Our goal was also to determine whether the residual pathological size of the tumour in breast could be correlated with pathological node status. Between 1982 and 2000, 451 consecutive patients were registered into five prospective phase II trials. After six cycles, 396 patients underwent surgery with axillary dissection for 277 patients (69.9%). Pathological response was evaluated according to the Chevallier's classification. At a median follow-up of 8 years, survival was analysed as a function of pathological response. A pathological complete response rate was obtained in 60 patients (15.2%) after induction chemotherapy. Breast tumour persistence was significantly related to positive axillary nodes (P=5.10 76 ). At 15 years, overall survival and disease-free survival rates were significantly higher in the group who had a pathological complete response than in the group who had less than a pathological complete response (P=0.047 and P=0.024, respectively). In the absence of pathological complete response and furthermore when there is a notable remaining pathological disease, axillary dissection is still important to determine a major prognostic factor and subsequently, a second non cross resistant adjuvant regimen or high dose chemotherapy could lead to a survival benefit.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

et al. 2002

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“…Although no more effective than post-operative treatment in improving survival, it has been shown to downstage large operable tumours, and increase the proportion of women who can be offered breast-conserving surgery (BCS), where previously a mastectomy would have been required (Hortobagyi et al, 1983). Neoadjuvant therapy also identifies the proportion of women achieving a complete pathological remission who are likely to have an excellent prognosis, and conversely, those for whom further treatment may be necessary (Feldman et al, 1986;Singletary et al, 2002).…”

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confidence: 99%

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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Contrast-enhanced magnetic resonance imaging (MRI) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery (BCS). Patients were prospectively recruited to undergo MRI as well as conventional methods of clinical examination, mammography (MM) and ultrasonography (USS) and response was assessed by each of these methods. Thirty-two patients with primary breast cancer were recruited. Magnetic resonance imaging correlation with histopathological size (r ¼ 0.71) was superior to USS (r ¼ 0.65) and to MM where tumour size was not measurable following chemotherapy in 71% of patients. Magnetic resonance imaging had 87.5% sensitivity (95% CI ¼ 68 -97%) and 50% specificity (95% CI ¼ 16 -84%) for a PPV (positive predictive value) of 99.8% and NPV (negative predictive value) of 80% for the detection of residual invasive cancer. Magnetic resonance imaging displayed 80% sensitivity (95% CI ¼ 28.4 -99.5%) and 89% specificity (95% CI ¼ 71 -98%) to detect pathological pCR in the breast. Eighty-four per cent of recruited patients were identified as potentially suitable candidates for BCS following chemotherapy and of those choosing to accept BCS, breast conservation was achieved in 90.5%, or 65.6% of all patients. Of those who proceeded to BCS, 9.5% required a re-do mastectomy because of positive margins; however, no residual tumour was found on histological examination of mastectomy specimens. Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy.

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“…treatment for this is multidisciplinary, consisting of preoperative chemotherapy, surgery, radiotherapy and postoperative chemotherapy (4)(5)(6).…”

Section: Introductionmentioning

confidence: 93%

“…It has been found to substantially improve the survival of these patients (6,11,12). It provides better local control over the disease, with increased likelihood that the breast surgery will be conservative (4,5,13).…”

Section: Introductionmentioning

confidence: 99%

99mTc-sestamibi scintigraphy used to evaluate tumor response to neoadjuvant chemotherapy in locally advanced breast cancer: A quantitative analysis

Koga

Moriguchi²,

Neto³

et al. 2010

Oncology Letters

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Abstract. to evaluate the tumor response to neoadjuvant chemotherapy, 99m tc-sestamibi breast scintigraphy was proposed as a quantitative method. Fifty-five patients with ductal carcinoma were studied. they underwent breast scintigraphy before and after neoadjuvant chemotherapy, along with clinical assessment and surgical specimen analysis. the regions of interest on the lesion and contralateral breast were identified, and the pixel counts were used to evaluate lesion uptake in relation to background radiation. the ratio of these counts before to after neoadjuvant chemotherapy was assessed. the decrease in uptake rate due to chemotherapy characterized the scintigraphy tumor response. the Kruskal-Wallis test was used to compare the mean scintigraphic tumor response and histological type. Dunn's multiple comparison test was used to detect differences between histological types. the MannWhitney test was used to compare means between quantitative and qualitative variables: scintigraphic tumor response vs. clinical response and uptake before chemotherapy vs. scintigraphic tumor response. the spearman's test was used to correlate the quantitative variables of clinical reduction in tumor size and scintigraphic tumor response. All of the variables compared presented significant differences. The change in 99m tc-sestamibi uptake noted on breast scintigraphy, before to after neoadjuvant chemotherapy, may be used as an effective method for evaluating the response to neoadjuvant chemotherapy, since this quantification reflects the biological behavior of the tumor towards the chemotherapy regimen.Furthermore, additional analysis on the uptake rate before chemotherapy may accurately predict treatment response. IntroductionBreast cancer is the second most common type of cancer worldwide and the most common among women. It accounts for approximately 22% of new cancer cases among women each year (1), and the 5-year survival rate among the worldwide population is 61%. this high mortality rate is related to late diagnosis, with the presence of tumors of large dimensions and lymph node metastases.locally advanced breast cancer comprises tumors greater than 5 cm in diameter, with wall or skin invasion, metastases to fixed lymph nodes (2,3) and inflammatory carcinoma. treatment for this is multidisciplinary, consisting of preoperative chemotherapy, surgery, radiotherapy and postoperative chemotherapy (4-6).Preoperative or neoadjuvant chemotherapy is standard treatment for individuals with locally advanced breast cancer (7-10). It has been found to substantially improve the survival of these patients (6,11,12). It provides better local control over the disease, with increased likelihood that the breast surgery will be conservative (4,5,13). Moreover, this type of chemotherapy treats preexisting microscopic systemic disease and enables the evaluation of tumor resistance in vivo (14). reduction in tumor volume has been used as the standard criterion for response evaluation among solid tumors such as breast carcinoma (15). techniques tha...

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Multimodal treatment of locoregionally advanced breast cancer

Cited by 225 publications

References 10 publications

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

99mTc-sestamibi scintigraphy used to evaluate tumor response to neoadjuvant chemotherapy in locally advanced breast cancer: A quantitative analysis

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