Selection of local therapy after neoadjuvant chemotherapy in patients with stage IIIA,B breast cancer

Danforth, David N.; Zujewski, Jo Anne; O’Shaughnessy, Joyce; Riseberg, David; Steinberg, Seth M.; McAtee, Nanette; Noone, Marianne; Chow, Catherine; Chaudhry, Usha; Lippman, Marc E.; Jacobson, Joan; Okunieff, Paul; Cowan, Kenneth H.

doi:10.1007/bf02303848

Cited by 41 publications

(28 citation statements)

References 15 publications

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“…At the time these patients were treated, our institution was actively pursuing this strategy to downstage tumors. Though no statistical relationship was identified between the receipt of preoperative chemotherapy and margin status, investigators have reported high rates of success in achieving negative margins in patients receiving neoadjuvant chemotherapy [17,18].…”

Section: Discussionmentioning

confidence: 98%

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Positive margins following surgical resection of breast carcinoma: Analysis of pathologic correlates

Miller¹,

Brandao

Prihoda

et al. 2004

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 98%

“…Tumor size (!2 cm) has been identified in many series as a factor associated with margin positivity and, by extension, of higher local recurrence rates [17][18][19][20][21][22]. However, certain large series have not identified such a relationship [23,24].…”

Section: Discussionmentioning

confidence: 99%

Positive margins following surgical resection of breast carcinoma: Analysis of pathologic correlates

Miller¹,

Brandao

Prihoda

et al. 2004

Journal of Surgical Oncology

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“…They found that 42 (33%) of them were downstaged to the extent that breast conservation surgery became a feasible technique for them. 15 In other study, Yadav et al reported that 23% of patients with locally advanced breast cancer are good candidates for breast conservation surgery after neoadjuvant chemotherapy provided that they are carefully selected. …”

Section: Discussionmentioning

confidence: 99%

A study on role of neo adjuvant chemotherapy in locally advanced non-metastatic breast cancer

Siddhartha

Kanchana

2018

Int Surg J

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Background: Nearly 1.7 million new breast cancer cases were diagnosed worldwide in 2012.Breast cancer is the second most common cancer in women worldwide. Globally, breast cancer now represents one in four of all cancers in women. breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,00 women and mortality 12.7 per 100,000 women. Around 90,000 new cases of breast cancer are diagnosed every year in India and majority present as Locally Advanced Breast Cancer (LABC). Neo adjuvant chemotherapy is a commonly used modality for LABC, that gives an upfront systemic therapy in high risk patients with expected micro metastatic burden and also helps in down staging the disease and offering radical cure.Methods: All Locally Advanced Non-Metastatic Breast Carcinoma (T3 N0, T3 N1, T4a, T4b, T4c, Any N2/N3, MO patients who received Neo Adjuvant Chemotherapy and underwent surgery were included. All these patients received 5-Fluorouracil, Adriamycin and Cyclophosphamide (FAC) regime, following therapy patients were offered either Modified Radical Mastectomy or Breast Conservative Surgery with axillary node dissection and Radiotherapy.Results: Complete response was achieved in 20 (66.6%) patients,3 (10%) of the patients had partial response and 7 (23.3%) progressed clinically.Conclusions: Neo adjuvant chemotherapy helped to study response of tumour size to NAC, down stage disease and to convert inoperable cases to resectability.

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“…Some authors have shown that advanced stage, margin positivity and residual primary tumor >2 cm [12, 33, 36] were associated with a significantly increased rate of LRR. In our series, 5 patients (62.5%) had less than pCR (gross residual disease in breast), suggesting that the lack of achieving pCR did not preclude successful BCT following primary chemotherapy, when it complied with careful patient selection [37]. …”

Section: Discussionmentioning

confidence: 99%

Dose-Dense Primary Chemotherapy, as Part of Multidisciplinary Treatment, for Inoperable Stage III B Breast Cancer – Long-Term Results of a Phase II Trial

Massidda¹,

Atzori²,

Scanu³

et al. 2007

Oncology

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Background: Primary chemotherapy as part of multidisciplinary approach is the established treatment for inoperable stage III B breast cancer. The primary endpoints were conversion to operable disease and feasibility of conservative surgery (breast-conserving therapy: BCT); secondary were clinical and pathological complete response rate, local and distant control and safety of the primary regimen. Methods: Between 1998 and 2001, 40 inoperable breast cancer patients ≤60 years, 72% T4abc and 28% T4d, received 6 cycles of primary PEV dose-dense regimen: cisplatin 50 mg/m², epirubicin 100 mg/m² and vinorelbine 25 mg/m², i.v. (q 14). Modified radical mastectomy (MRM) or BCT was performed, followed by adjuvant chemotherapy, radiotherapy and hormone therapy. Results: All patients were converted to operable disease, and BCT was feasible in 24% of T4abc patients. After a median follow-up of 84 months (range 58–96), local and distant relapses were 7.5% (0% in BCT ) and 25% (25% in BCT), respectively. Clinical response was 80% (clinical complete response [cCR]: 20%); pathological complete response (pCR) was 40% in breast, 50% in axilla (pLN0); 32% both in breast and axilla. Neutropenia (G4, 30%), leukopenia (G4, 25%), alopecia (G2, 100%), nausea and vomiting (G4, 20%) were the most common toxicities. Conclusions: The PEV dose-dense regimen seems to be highly effective in terms of resectability and pCR. Toxicity, mainly hematological, was acceptable. Successful BCT is feasible, in selected patients, without compromising local and distant control.

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Selection of local therapy after neoadjuvant chemotherapy in patients with stage IIIA,B breast cancer

Abstract: These findings support a selective approach to local therapy in patients with stage IIIA,B breast cancer. This approach provides local control in most patients, and allows for breast preservation and elimination of axillary dissection in selected patients.

Cited by 41 publications

References 15 publications

Positive margins following surgical resection of breast carcinoma: Analysis of pathologic correlates

Positive margins following surgical resection of breast carcinoma: Analysis of pathologic correlates

A study on role of neo adjuvant chemotherapy in locally advanced non-metastatic breast cancer

Dose-Dense Primary Chemotherapy, as Part of Multidisciplinary Treatment, for Inoperable Stage III B Breast Cancer – Long-Term Results of a Phase II Trial

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