Neoadjuvant Therapy Should Be the Standard of Care for Every Node Positive Breast Cancer Patient

Hamdy, Omar

doi:10.4048/jbc.2019.22.e3

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…Currently, neoadjuvant chemotherapy (NACT) is widely used as rst of multidisciplinary management of breast cancer without distant metastases [16,17,18,19]. Besides reducing the tumour mass and thereby offering better conditions for local treatment (BCT -breast conserving therapy), NACT provides professionals with unique opportunities for in vivo chemotherapeutic evaluation of cancer cells' sensitivity and for the quest of new biomarkers of therapeutic response, and -in the event of poor response and progression of the disease -it offers a chance to alter the treatment scheme or refer a given patient for surgical treatment [20,21].…”

Section: Discussionmentioning

confidence: 99%

Radiological Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Females, Using Standard and Spectral Mammography

Steinhof-Radwańska

Grażyńska

Lorek

et al. 2021

Preprint

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Background Morphological assessment and measurement of the residual mass of the breast tumour following neoadjuvant chemotherapy (NACT) is the key to successful surgical treatment. The objective of our study was to evaluate the efficiency of contrast-enhanced spectral mammography (CESM) and conventional mammography (MMG) in detecting CR (complete response) following NACT, as well as to compare the efficiency of conventional mammography and contrast-enhanced spectral mammography is assessing the therapeutic response to NACT in breast cancer patients.Methods A retrospective analysis included 63 breast cancer subjects who had undergone neoadjuvant chemotherapy in the years 2016-2019. The inclusion criteria for the study included diagnosed breast cancer based on a core needle biopsy, a complete set of imaging examinations before the procedure consisted of digital mammography, contrast-enhanced spectral mammography and surgery performed before and after completed neoadjuvant chemotherapy. Results The average size of the tumours prior to neoadjuvant chemotherapy amounted to 34.37 mm for MMG and 34.34 mm for CESM, as well as 17.61 mm for MMG and 8.48 mm for CESM following NACT. The average size of the lesions in histopathological examination was 11.06 mm. Spearman’s analysis revealed a high level of correlation (R=0.89, p<0.01) upon comparing the maximum tumour dimensions prior to neoadjuvant chemotherapy on MMG and CESM, and a moderate level of correlation (R=0.57, p<0.01) upon comparing the maximum tumour dimensions post-NACT on MMG and CESM. While comparing the measurements of the maximum dimensions on MMG and CESM following NACT, with the maximum dimensions in histopathological examination, we can observe a low level of correlation for MMG (R=0.26, p<0.04) and a high level of correlation for CESM (R=0.67, p<0.01). The sensitivity of MMG in forecasting CR amounted to 33.33% and its specificity to 92.86%, whereas the same parameters for CESM were 85.71% and 71.42% respectively.Conclusions CESM demonstrates significantly higher sensitivity than MMG in forecasting CR in female patients receiving NACT due to breast cancer. CESM correlates well with the size of residual lesions in histopathological examination. However, it tends to underestimate the tumour size. In the assessment of post-NACT residual lesions, conventional mammography is an insufficient diagnostic tool.

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Section: Discussionmentioning

confidence: 99%

Radiological Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Females, Using Standard and Spectral Mammography

Steinhof-Radwańska

Grażyńska

Lorek

et al. 2021

Preprint

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“…18 In addition, upfront surgery might delay systemic treatment, or in case of significant postoperative deconditioning and/ or development of debilitating complications (ie, persistent enterocutaneous fistula), might render patients unfit for standard adjuvant systemic therapy, which will significantly impact outcomes in those patients. [19][20][21]…”

Section: Discussionmentioning

confidence: 99%

Is There a Role for Neoadjuvant Systemic Therapy for cT4bM0 Colon Cancer? A Propensity-Score Matched Analysis of the National Cancer Database

Kamel

Shchatsko

Keane

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Nonmetastatic T4b colon cancer has been traditionally treated with upfront surgery, often requiring technically challenging multiorgan resection. Neoadjuvant chemotherapy can potentially downsize these tumors and improve their resectability. OBJECTIVE: This study aimed to explore trends and outcomes of neoadjuvant chemotherapy use compared to upfront surgery in patients with nonmetastatic T4b colon cancer. This study also sought to determine factors associated with increased neoadjuvant chemotherapy use and with overall survival. DESIGN: Retrospective cohort study. SETTINGS: Conducted using the National Cancer Database. PATIENTS: Patients with nonmetastatic T4b colon cancer who underwent colectomy (2006–2016) were included in the study. Patients receiving neoadjuvant chemotherapy were propensity-matched (1:2) to those who underwent upfront surgery in either clinically node-negative or node-positive disease. MAIN OUTCOME MEASURES: Postoperative outcomes (length of stay, 30-d readmission, 30/90-d mortality), oncologic resection adequacy (R0 rate, number of resected/positive nodes), and overall survival were the main outcome measures. RESULTS: Neoadjuvant chemotherapy was used in 7.7% of the patients. Neoadjuvant chemotherapy use increased over the study period from 4% to 16% in the entire cohort, from 3% to 21% in patients with clinically node-positive disease, and from 6% to 12% in patients with clinically node-negative disease. Factors associated with increased use of neoadjuvant chemotherapy included younger age (OR 0.97; 95% CI, 0.96–0.98; p < 0.001), male sex (OR 1.35; 95% CI, 1.11–1.64; p = 0.002), recent diagnosis year (OR 1.16; 95% CI, 1.12–1.20; p < 0.001), academic centers (OR 2.65; 95% CI, 2.19–3.22; p < 0.001), clinically node-positive (OR 1.23; 95% CI, 1.01–1.49; p = 0.037), and tumor located in the sigmoid colon (OR 2.44; 95% CI, 1.97–3.02; p < 0.001). Patients who received neoadjuvant chemotherapy had significantly higher R0 resection compared with upfront surgery (87% vs 77%; p < 0.001). On multivariable analysis, neoadjuvant chemotherapy was associated with higher overall survival (HR 0.76; 95% CI, 0.64–0.91; p = 0.002). On propensity-matched analyses, neoadjuvant chemotherapy was associated with a higher 5-year overall survival compared to upfront surgery in patients with clinically node-positive disease (57% vs 43%; p = 0.003) but not in patients with clinically node-negative disease (61% vs 56%; p = 0.090). LIMITATIONS: Retrospective design. CONCLUSION: Neoadjuvant chemotherapy use for nonmetastatic T4b has increased significantly on the national level, more so in patients with clinically node-positive disease. Patients with node-positive disease treated with neoadjuvant chemotherapy had higher overall survival compared to those who underwent upfront surgery. See Video Abstract at http://links.lww.com/DCR/C228. ¿EXISTE LUGAR PARA LA TERAPIA SISTÉMICA NEOADYUVANTE PARA EL CÁNCER DE COLON CT4BM0? UN ANÁLISIS EMPAREJADO DE PUNTAJE DE PROPENSIÓN DE LA BASE DE DATOS NACIONAL DEL CÁNCER ANTECEDENTES: El cáncer de colon T4b no metastásico se ha tratado tradicionalmente con cirugía inicial, que frecuentemente requiere de una resección multiorgánica técnicamente desafiante. La quimioterapia neoadyuvante puede potencialmente reducir el tamaño y mejorar la resecabilidad de esos tumores. OBJETIVO: Explorar las tendencias y los resultados del uso de quimioterapia neoadyuvante en pacientes con cáncer de colon T4b no metastásico, en comparación con la cirugía inicial. Determinar los factores asociados con el aumento del uso de quimioterapia neoadyuvante y con la supervivencia general. DISEÑO: Estudio de cohorte retrospectivo. AJUSTES: Utilizando de la Base de Datos Nacional del Cáncer. PACIENTES: Pacientes con cáncer de colon T4b no metastásico sometidos a colectomía (2006-2016). Los pacientes que recibieron quimioterapia neoadyuvante fueron emparejados por propensión (1:2) con aquellos sometidos a cirugía inicial, ya sea en enfermedad clínica con ganglios negativos o ganglios positivos. PRINCIPALES MEDIDAS DE RESULTADO: Resultados posoperatorios (duración de la hospitalización, reingreso a los 30 días, mortalidad a los 30/90 días), adecuación de la resección oncológica (tasa R0, número de ganglios resecados/positivos) y supervivencia general. RESULTADOS: La quimioterapia neoadyuvante se utilizó en el 7,7% de los pacientes. El uso de quimioterapia neoadyuvante aumentó durante el período de estudio del 4% al 16% en toda la cohorte; del 3% al 21% en pacientes con enfermedad clínica y ganglios positivos; y del 6% al 12% en pacientes con enfermedad clínica y ganglios negativos. Los factores asociados con un mayor uso de quimioterapia neoadyuvante incluyeron, edad más joven (OR 0,97, IC del 95 %: 0,96–0,98, p < 0,001), sexo masculino (OR 1,35, IC del 95 %: 1,11–1,64, p = 0,002), año de diagnóstico mas reciente (OR 1,16, 95% IC: 1,12–1,20, p < 0,001), centros académicos (OR 2,65, 95% IC: 2,19–3,22, p < 0,001), enfermedad clínica con ganglios positivos (OR 1,23, 95% IC: 1,01–1,49, p = 0,037), y tumor localizado en colon sigmoide (OR 2,44, 95% IC: 1,97–3,02, p < 0,001). Los pacientes que recibieron quimioterapia neoadyuvante tuvieron una resección R0 significativamente mayor en comparación con la cirugía inicial (87 % frente a 77 %, p < 0,001). En análisis multivariable, la quimioterapia neoadyuvante se asoció con una mayor supervivencia global (HR 0,76, IC del 95%: 0,64–0,91, p = 0,002). En los análisis de propensión pareada, la quimioterapia neoadyuvante se asoció con una mayor supervivencia general a los 5 años en comparación con la cirugía inicial en pacientes con enfermedad clínica con ganglios positivos (57% frente a 43%, p = 0,003), pero no en pacientes con enfermedad clínica y ganglios negativos (61% vs 56%, p = 0,090). LIMITACIONES: Diseño retrospectivo. CONCLUSIÓN: El uso de quimioterapia neoadyuvante para T4b no metastásico ha aumentado significativamente a nivel nacional, más aún en pacientes con enfermedad clínica y ganglios positivos. Los pacientes con enfermedad y ganglios positivos tratados con quimioterapia neoadyuvante tuvieron una mayor supervivencia general en comparación con la cirugía inicial. Consulte Video Resumen en http://links.lww.com/DCR/C228. (Traducción—Dr. Fidel Ruiz Healy)

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“…Anticancer therapy has also been reported to be a key factor in pain management in patients with breast cancer. Domestic and international guidelines recommend or approve neoadjuvant chemotherapy for patients with specific clinical conditions [37,38]. However, according to a previous study by Schott et al, patients receiving neoadjuvant chemotherapy had a high risk of developing peripheral neuropathy, a representative side effect of chemotherapy, and other types of side effects, such as impaired cardiac function, nausea, and vomiting, which may affect surgical outcomes after chemotherapy [39,40].…”

Section: Plos Onementioning

confidence: 99%

Changes in lymph node surgery in breast cancer and preoperative drug prescription analysis for postoperative pain management: A retrospective, cross-sectional study

Kang,

Lim,

Jang

et al. 2024

PLoS ONE

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This study aimed to investigate the changes in lymph node surgery types and prescription patterns of postoperative medications for pain management in patients with breast cancer using national health insurance claim data from South Korea. The study population comprised patients with at least one record of a principal diagnosis of breast cancer (ICD-10 code: C50) from the national health insurance claim database between 2010 and 2019. Patients who underwent mastectomy or lumpectomy only once were selected for the analysis. Patients who underwent axillary lymph node dissection (ALND) with mastectomy or lumpectomy on the day of surgery were included in the ALND group, whereas those who underwent sentinel lymph node biopsy (SLNB) were included in the SLNB group. Prescription records of opioids before, after and on the date of breast cancer surgery were collected and categorized according to the opioid type. Multivariate logistic regression modeling was used to compare postoperative opioid prescriptions. The proportion of those undergoing ALND among 3,080 patients decreased consistently after 2014, while the proportion undergoing SLNB increased. Although the rate of pain medication prescription on the day of surgery was similar between the two groups, the rate of prescription of postoperative pain medication and anticancer agents was lower in the SLNB group than in the ALND group. Logistic regression modeling showed that the SLNB group had lower odds of receiving opioids than did the ALND group (Odds ratio (OR) = 0.727, Confidence Interval (CI) = 0.546–0.970). A consistent trend was observed when the model was adjusted for neoadjuvant chemotherapy and the use of preoperative pain medications (OR = 0.718, CI = 0.538–0.959). To manage postoperative pain and prevent chronic pain with minimal side effects, sufficient discussion among clinicians, patients, and other healthcare professionals is imperative, along with adequate treatment planning.

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Neoadjuvant Therapy Should Be the Standard of Care for Every Node Positive Breast Cancer Patient

Cited by 6 publications

References 24 publications

Radiological Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Females, Using Standard and Spectral Mammography

Radiological Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Females, Using Standard and Spectral Mammography

Is There a Role for Neoadjuvant Systemic Therapy for cT4bM0 Colon Cancer? A Propensity-Score Matched Analysis of the National Cancer Database

Changes in lymph node surgery in breast cancer and preoperative drug prescription analysis for postoperative pain management: A retrospective, cross-sectional study

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