Predictive factors for local recurrence after breast conservative surgery following neoadjuvant chemotherapy: Our long-term results

Abstract

OBJECTIVES There is still no consensus on the eligibility criteria for breast conservation after neoadjuvant chemotherapy in patients with breast cancer. The present study investigated the long term outcome in patients with breast conservation following chemotherapy to determine its feasibility. METHODS Between January 1991 to July 2005, 29 patients with clinical stage 2 or 3 who underwent breast conservative surgery following chemotherapy, were included into the study. RESULTS The clinical stages before neoadjuvant chemotherapy were as follows: T0 (n=1), T1 (n=1), T2 (n=14), T3 (n=7), and T4 ( n= 6); and N0 (n=2), N1 (n=9), and N2 (n=17), and N3 (n=1). Out of 4 ipsilateral breast tumor recurrences, 2 local recurrences (7%) were detected in the first 5 years, whereas 4 local recurrences (14%) were detected in the first 10 years. The 5-year and 10- year local recurrence free rates were 91.5% and 75%, and the 5-year and 10-year overall survival rates were 92% and 78%, respectively. The 10-year local recurrence-free survival rate was only found to be higher in patients with T0-2 tumors compared to patients with T3-4 tumors (86%, vs 60%, p=0.078). CONCLUSION Breast conservation after neoadjuvant chemotherapy seems to be safe in selected patients with locally advanced disease including those with clinical T0-2 tumors before neoadjuvant chemotherapy.

Keywords

• Breast Neoplasms,Neoadjuvant Therapy,Combined Modality Therapy,Chemotherapy,Antineoplastic Combined Chemotherapy Protocols,Mastectomy, Segmental,Recurrence

Neoadjuvan kemoterapi sonrası meme koruyucu cerrahide lokal nüksü etkileyen faktörler: Uzun dönem sonuçlarımız

Öz

AMAÇ Meme kanserinde neoadjuvan kemoterapi sonrası meme koruyucu cerrahi (MKC) için uygun seçim kriterleri konusunda henüz konsensüs sağlanmamıştır. Bu çalışmada, neoadjuvan kemoterapi sonrası MKC yapılan hastalardaki uzun dönem sonuçları sunuldu. GEREÇ VE YÖNTEM Ocak 1991-Temmuz 2005 tarihleri arasında neoadjuvan kemoterapi verilen klinik evre 2 ve evre 3 toplam 244 hastadan MKC uygulanan 29 hasta çalışmaya alınarak lokal nükse etkili faktörler araştırıldı. BULGULAR TNM sınıflamasına göre kemoterapi öncesi hastaların biri T0, biri T1, 14'ü T2, 7'si T3, 6'sı T4 ve 2 hasta N0, 9 hasta N1, 17 hasta N2 ve 1 hasta N3 olarak değerlendirildi. İlk beş yılda 2 hastada (%7) ve 10 yılda toplam 4 hastada (%14) ipsilateral memede tümör nüksü saptandı. Beş yıllık ve 10 yıllık lokal nükssüz sağkalım oranları sırasıyla %91,5 ve %75 ve genel sağkalım oranları da sırasıyla %92 ve %78 bulundu. Lokal nükse etkili faktörler araştırıldığında kemoterapi öncesi T0-2 hastalarda T3-4 hastalara göre 10 yıllık lokal nükssüz sağkalım oranı daha yüksek bulundu (%86 ile %60; p=0,078). SONUÇ Lokal ileri meme kanserinde neoadjuvan kemoterapi sonrası meme koruyucu cerrahi başlangıç klinik evresi T0-2 hastalarda onkolojik olarak daha güvenle yapılabilmektedir.

Anahtar Kelimeler

• Lokal ileri meme kanseri, meme koruyucu cerrahi, neoadjuvan kemoterapi.

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