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

Year 2008, Volume: 23 Issue: 2, 81 - 90, 01.03.2008

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.

References

  • 1. Lee MC, Newman LA. Management of patients with locally advanced breast cancer. Surg Clin North Am 2007;87(2):379-98, ix.
  • 2. Wolff AC, Davidson NE. Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease. Oncologist 2002;7(3):239-45.
  • 3. Buchholz TA, Hunt KK, Whitman GJ, Sahin AA, Hortobagyi GN. Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks. Cancer 2003;98(6):1150-60.
  • 4. Kuerer HM, Sahin AA, Hunt KK, Newman LA, Breslin TM, Ames FC, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg 1999;230(1):72-8.
  • 5. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 2001;(30):96-102.
  • 6. Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev 2007;(2):CD005002.
  • 7. Hortobagyi GN. Multidisciplinary management of advanced primary and metastatic breast cancer. Cancer 1994;74(1 Suppl):416-23.
  • 8. Hortobagyi GN, Ames FC, Buzdar AU, Kau SW, McNeese MD, Paulus D, et al. Management of stage III primary breast cancer with primary chemotherapy, s u rg e r y, and radiation therapy. Cancer 1988;62(12):2507-16.
  • 9. Green M, Hortobagyi GN. Neoadjuvant chemotherapy for operable breast cancer. Oncology (Williston Park) 2002;16(7):871-98.
  • 10. Singletary SE, McNeese MD, Hortobagyi GN. Feasibility of breast-conservation surgery after induction chemotherapy for locally advanced breast carcinoma. Cancer 1992;69(11):2849-52.
  • 11. Bonadonna G, Veronesi U, Brambilla C, Ferrari L, Luini A, Greco M, et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst 1990;82(19):1539-45.
  • 12. Veronesi U, Bonadonna G, Zurrida S, Galimberti V, Greco M, Brambilla C, et al. Conservation surgery after primary chemotherapy in large carcinomas of the breast. Ann Surg 1995;222(5):612-8.
  • 13. Vlastos G, Mirza NQ, Lenert JT, Hunt KK, Ames FC, Feig BW, et al. The feasibility of minimally invasive surgery for stage IIA, IIB, and IIIA breast carcinoma patients after tumor downstaging with induction chemotherapy. Cancer 2000;88(6):1417-24.
  • 14. Newman LA, Buzdar AU, Singletary SE, Kuerer HM, Buchholz T, Ames FC, et al. A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility. Ann Surg Oncol 2002;9(3):228-34.
  • 15. Kuerer HM, Singletary SE, Buzdar AU, Ames FC, Valero V, Buchholz TA, et al. Surgical conservation planning after neoadjuvant chemotherapy for stage II and operable stage III breast carcinoma. Am J Surg 2001;182(6):601-8.
  • 16.Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Oswald MJ, Outlaw ED, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol 2004;22(12):2303-12.
  • 17.Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Outlaw ED, Strom EA, et al. Breast conservation after neoadjuvant chemotherapy. Cancer 2005;103(4):689- 95.
  • 18. Shen J, Valero V, Buchholz TA, Singletary SE, Ames FC, Ross MI, et al. Effective local control and longterm survival in patients with T4 locally advanced breast cancer treated with breast conservation therapy. Ann Surg Oncol 2004;11(9):854-60.
  • 19.Rouzier R, Mathieu MC, Sideris L, Youmsi E, Rajan R, Garbay JR, et al. Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors. Cancer 2004;101(5):918-25.
  • 20. Gralow JR, Burstein HJ, Wood W, Hortobagyi GN, Gianni L, von Minckwitz G, et al. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol 2008;26(5):814-9.
  • 21. Peintinger F, S Boughey JC, Buzdar AU, Yu TK, et al. The safety of breast-conserving surgery in patients who achieve a complete pathologic response after neoadjuvant chemotherapy. Cancer 2006;107(6):1248-54.
  • 22. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47(1):207-14.
  • 23.Rouzier R, Pusztai L, Garbay JR, Delaloge S, Hunt KK, Hortobagyi GN, et al. Development and validation of nomograms for predicting residual tumor size and the probability of successful conservative surgery with neoadjuvant chemotherapy for breast cancer. Cancer 2006;107(7):1459-66.
  • 24. von Minckwitz G, Blohmer JU, Raab G, Löhr A, Gerber B, Heinrich G, et al. In vivo chemosensitivityadapted preoperative chemotherapy in patients with early-stage breast cancer: the GEPA RTRIO pilot study. Ann Oncol 2005;16(1):56-63.
  • 25. von Minckwitz G, Raab G, Caputo A, Schütte M, Hilfrich J, Blohmer JU, et al. Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: the GEPARDUO study of the German Breast Group. J Clin Oncol 2005;23(12):2676-85.
  • 26.Clouth B, Chandrasekharan S, Inwang R, Smith S, Davidson N, Sauven P. The surgical management of patients who achieve a complete pathological response after primary chemotherapy for locally advanced breast cancer. Eur J Surg Oncol 2007;33(8):961-6.
  • 27. Edeiken BS, Fornage BD, Bedi DG, Singletary SE, Ibrahim NK, Strom EA, et al. US-guided implantation of metallic markers for permanent localization of the tumor bed in patients with breast cancer who undergo p r e o p e r a t i v e c h e m o t h e r a p y. Radiology 1999;213(3):895-900.
  • 28. Oh JL, Nguyen G, Whitman GJ, Hunt KK, Yu TK, Woodward WA, et al. Placement of radiopaque clips for tumor localization in patients with breast cancer u n d e rgoing neoadjuvant chemotherapy and breast conservation therapy. Cancer 2007;110(11):2420-27.

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

Year 2008, Volume: 23 Issue: 2, 81 - 90, 01.03.2008

Abstract

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.

References

  • 1. Lee MC, Newman LA. Management of patients with locally advanced breast cancer. Surg Clin North Am 2007;87(2):379-98, ix.
  • 2. Wolff AC, Davidson NE. Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease. Oncologist 2002;7(3):239-45.
  • 3. Buchholz TA, Hunt KK, Whitman GJ, Sahin AA, Hortobagyi GN. Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks. Cancer 2003;98(6):1150-60.
  • 4. Kuerer HM, Sahin AA, Hunt KK, Newman LA, Breslin TM, Ames FC, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg 1999;230(1):72-8.
  • 5. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 2001;(30):96-102.
  • 6. Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev 2007;(2):CD005002.
  • 7. Hortobagyi GN. Multidisciplinary management of advanced primary and metastatic breast cancer. Cancer 1994;74(1 Suppl):416-23.
  • 8. Hortobagyi GN, Ames FC, Buzdar AU, Kau SW, McNeese MD, Paulus D, et al. Management of stage III primary breast cancer with primary chemotherapy, s u rg e r y, and radiation therapy. Cancer 1988;62(12):2507-16.
  • 9. Green M, Hortobagyi GN. Neoadjuvant chemotherapy for operable breast cancer. Oncology (Williston Park) 2002;16(7):871-98.
  • 10. Singletary SE, McNeese MD, Hortobagyi GN. Feasibility of breast-conservation surgery after induction chemotherapy for locally advanced breast carcinoma. Cancer 1992;69(11):2849-52.
  • 11. Bonadonna G, Veronesi U, Brambilla C, Ferrari L, Luini A, Greco M, et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst 1990;82(19):1539-45.
  • 12. Veronesi U, Bonadonna G, Zurrida S, Galimberti V, Greco M, Brambilla C, et al. Conservation surgery after primary chemotherapy in large carcinomas of the breast. Ann Surg 1995;222(5):612-8.
  • 13. Vlastos G, Mirza NQ, Lenert JT, Hunt KK, Ames FC, Feig BW, et al. The feasibility of minimally invasive surgery for stage IIA, IIB, and IIIA breast carcinoma patients after tumor downstaging with induction chemotherapy. Cancer 2000;88(6):1417-24.
  • 14. Newman LA, Buzdar AU, Singletary SE, Kuerer HM, Buchholz T, Ames FC, et al. A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility. Ann Surg Oncol 2002;9(3):228-34.
  • 15. Kuerer HM, Singletary SE, Buzdar AU, Ames FC, Valero V, Buchholz TA, et al. Surgical conservation planning after neoadjuvant chemotherapy for stage II and operable stage III breast carcinoma. Am J Surg 2001;182(6):601-8.
  • 16.Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Oswald MJ, Outlaw ED, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol 2004;22(12):2303-12.
  • 17.Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Outlaw ED, Strom EA, et al. Breast conservation after neoadjuvant chemotherapy. Cancer 2005;103(4):689- 95.
  • 18. Shen J, Valero V, Buchholz TA, Singletary SE, Ames FC, Ross MI, et al. Effective local control and longterm survival in patients with T4 locally advanced breast cancer treated with breast conservation therapy. Ann Surg Oncol 2004;11(9):854-60.
  • 19.Rouzier R, Mathieu MC, Sideris L, Youmsi E, Rajan R, Garbay JR, et al. Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors. Cancer 2004;101(5):918-25.
  • 20. Gralow JR, Burstein HJ, Wood W, Hortobagyi GN, Gianni L, von Minckwitz G, et al. Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol 2008;26(5):814-9.
  • 21. Peintinger F, S Boughey JC, Buzdar AU, Yu TK, et al. The safety of breast-conserving surgery in patients who achieve a complete pathologic response after neoadjuvant chemotherapy. Cancer 2006;107(6):1248-54.
  • 22. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47(1):207-14.
  • 23.Rouzier R, Pusztai L, Garbay JR, Delaloge S, Hunt KK, Hortobagyi GN, et al. Development and validation of nomograms for predicting residual tumor size and the probability of successful conservative surgery with neoadjuvant chemotherapy for breast cancer. Cancer 2006;107(7):1459-66.
  • 24. von Minckwitz G, Blohmer JU, Raab G, Löhr A, Gerber B, Heinrich G, et al. In vivo chemosensitivityadapted preoperative chemotherapy in patients with early-stage breast cancer: the GEPA RTRIO pilot study. Ann Oncol 2005;16(1):56-63.
  • 25. von Minckwitz G, Raab G, Caputo A, Schütte M, Hilfrich J, Blohmer JU, et al. Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: the GEPARDUO study of the German Breast Group. J Clin Oncol 2005;23(12):2676-85.
  • 26.Clouth B, Chandrasekharan S, Inwang R, Smith S, Davidson N, Sauven P. The surgical management of patients who achieve a complete pathological response after primary chemotherapy for locally advanced breast cancer. Eur J Surg Oncol 2007;33(8):961-6.
  • 27. Edeiken BS, Fornage BD, Bedi DG, Singletary SE, Ibrahim NK, Strom EA, et al. US-guided implantation of metallic markers for permanent localization of the tumor bed in patients with breast cancer who undergo p r e o p e r a t i v e c h e m o t h e r a p y. Radiology 1999;213(3):895-900.
  • 28. Oh JL, Nguyen G, Whitman GJ, Hunt KK, Yu TK, Woodward WA, et al. Placement of radiopaque clips for tumor localization in patients with breast cancer u n d e rgoing neoadjuvant chemotherapy and breast conservation therapy. Cancer 2007;110(11):2420-27.
There are 28 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Neslihan Cabıoğlu This is me

Mahmut Müslümanoğlu This is me

Abdullah İğci This is me

Beyza Özçınar This is me

Vahit Özmen This is me

Temel Dağoğlu This is me

Yeşim Eralp This is me

Maktav Dinçer This is me

İşık Aslay This is me

Ekrem Yavuz This is me

Mehtap Tunacı This is me

Adnan Aydıner This is me

Mustafa Keçer This is me

Publication Date March 1, 2008
Published in Issue Year 2008 Volume: 23 Issue: 2

Cite

APA Cabıoğlu, N., Müslümanoğlu, M., İğci, A., Özçınar, B., et al. (2008). Neoadjuvan kemoterapi sonrası meme koruyucu cerrahide lokal nüksü etkileyen faktörler: Uzun dönem sonuçlarımız. Türk Onkoloji Dergisi, 23(2), 81-90.
AMA Cabıoğlu N, Müslümanoğlu M, İğci A, Özçınar B, Özmen V, Dağoğlu T, Eralp Y, Dinçer M, Aslay İ, Yavuz E, Tunacı M, Aydıner A, Keçer M. Neoadjuvan kemoterapi sonrası meme koruyucu cerrahide lokal nüksü etkileyen faktörler: Uzun dönem sonuçlarımız. Türk Onkoloji Dergisi. March 2008;23(2):81-90.
Chicago Cabıoğlu, Neslihan, Mahmut Müslümanoğlu, Abdullah İğci, Beyza Özçınar, Vahit Özmen, Temel Dağoğlu, Yeşim Eralp, Maktav Dinçer, İşık Aslay, Ekrem Yavuz, Mehtap Tunacı, Adnan Aydıner, and Mustafa Keçer. “Neoadjuvan Kemoterapi Sonrası Meme Koruyucu Cerrahide Lokal nüksü Etkileyen faktörler: Uzun dönem sonuçlarımız”. Türk Onkoloji Dergisi 23, no. 2 (March 2008): 81-90.
EndNote Cabıoğlu N, Müslümanoğlu M, İğci A, Özçınar B, Özmen V, Dağoğlu T, Eralp Y, Dinçer M, Aslay İ, Yavuz E, Tunacı M, Aydıner A, Keçer M (March 1, 2008) Neoadjuvan kemoterapi sonrası meme koruyucu cerrahide lokal nüksü etkileyen faktörler: Uzun dönem sonuçlarımız. Türk Onkoloji Dergisi 23 2 81–90.
IEEE N. Cabıoğlu, “Neoadjuvan kemoterapi sonrası meme koruyucu cerrahide lokal nüksü etkileyen faktörler: Uzun dönem sonuçlarımız”, Türk Onkoloji Dergisi, vol. 23, no. 2, pp. 81–90, 2008.
ISNAD Cabıoğlu, Neslihan et al. “Neoadjuvan Kemoterapi Sonrası Meme Koruyucu Cerrahide Lokal nüksü Etkileyen faktörler: Uzun dönem sonuçlarımız”. Türk Onkoloji Dergisi 23/2 (March 2008), 81-90.
JAMA Cabıoğlu N, Müslümanoğlu M, İğci A, Özçınar B, Özmen V, Dağoğlu T, Eralp Y, Dinçer M, Aslay İ, Yavuz E, Tunacı M, Aydıner A, Keçer M. Neoadjuvan kemoterapi sonrası meme koruyucu cerrahide lokal nüksü etkileyen faktörler: Uzun dönem sonuçlarımız. Türk Onkoloji Dergisi. 2008;23:81–90.
MLA Cabıoğlu, Neslihan et al. “Neoadjuvan Kemoterapi Sonrası Meme Koruyucu Cerrahide Lokal nüksü Etkileyen faktörler: Uzun dönem sonuçlarımız”. Türk Onkoloji Dergisi, vol. 23, no. 2, 2008, pp. 81-90.
Vancouver Cabıoğlu N, Müslümanoğlu M, İğci A, Özçınar B, Özmen V, Dağoğlu T, Eralp Y, Dinçer M, Aslay İ, Yavuz E, Tunacı M, Aydıner A, Keçer M. Neoadjuvan kemoterapi sonrası meme koruyucu cerrahide lokal nüksü etkileyen faktörler: Uzun dönem sonuçlarımız. Türk Onkoloji Dergisi. 2008;23(2):81-90.