Breast conservation treatment in women with locally advanced breast cancer - experience from a single centre.
ABSTRACT In absence of randomized evidence to support safety of conservative surgery (BCT) in locally advanced breast cancer (LABC), we analyzed a cohort of 664 women with LABC treated during January 1998 to December 2002 at Tata Memorial Hospital, Mumbai, India.
All were treated with a multimodality regimen comprising of neoadjuvant chemotherapy (NACT) followed by surgery (modified radical mastectomy or BCT) and adjuvant radiotherapy and hormone therapy. The outcome was evaluated to assess safety of BCT.
71% (469/664) women responded to NACT (22% clinical CR and 49% PR) and 28.3% (188/664) underwent BCT. Positive lumpectomy margins were reported in 8.5%, with gross presence of tumor at the margins in 2.3% requiring a revision surgery. At a median follow-up of 30months, local relapse rate was 8% after BCT and 10.7% after mastectomy. The 3-year local DFS was better post-conservation than after mastectomy (87% vs 78%, P=0.02). The disease-free survival (DFS) was also superior after BCT, 72% vs 52% (P<0.001) at 3years and 62% vs 37% (P<0.001) at 5years respectively. On multivariate analysis, presence of lymphatic vascular emboli (LVE) was the major significant predictor of local recurrence (P<0.001, HR 2.52, 95% CI 1.52-4.18). DFS was better after BCT [(P<0.001, HR 2.0 (95% CI 1.38-2.91)]; shorter DFS was noted in LVE positive (HR 1.54, P=0.007) and larger residual disease after NACT (HR 1.13, P=0.001).
BCT is technically feasible and safe post neo-adjuvant chemotherapy in women with LABC with no detriment in outcome.
SourceAvailable from: Ricardo Cendales01/2009; 13(1):35-43. DOI:10.1016/S0123-9015(09)70150-7
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ABSTRACT: Background: Introduction of neoadjuvant chemotherapy (NACT) has dramatically changed the management of locally advanced breast cancer (LABC). However, very few randomized trials of NACT have been carried out specifically in LABC patients in our country. In this retrospective analysis, we presented our experience with NACT in LABC patients. Materials and Methods: Medical records of 148 patients of stage III LABC patients treated with NACT, followed by surgery and radiotherapy from January 2006 to December 2010 were reviewed. Clinical and pathological responses to different chemotherapy regimens were assessed according to World Health Organization criteria. Various factors influencing response to NACT and clinical outcome were identified and analyzed. Results: A total of 90 (60.8%) patients received anthracycline-based chemotherapy and 52 (35.1%) patients received mixed anthracycline and taxane-based chemotherapy.119 patients (80.4%) responded to NACT either in the form of complete or partial response (PR). Complete response was seen in 27 (18.2%) patients and 92 (62.2%) patients showed PR after NACT. Pathological complete response was seen in 24 (16.2%) patients-. At a median follow-up period of 44 months 36 patients (24.3%) developed relapse of which six patients developed locoregional recurrence, while 28 (18.9%) patients developed distant metastasis. Nodal status, response to chemotherapy, pathological tumor size <3 cm and extracapsular extension (ECE) came out to be important prognostic factors in this study. Conclusion: Neoadjuvant chemotherapy is a reasonable alternative to upfront surgery in the management of LABC. Clinicopathological variables such as nodal status, response to chemotherapy, pathological tumor size and presence of ECE had significant impact on disease free survival.Indian journal of medical and paediatric oncology 07/2014; 35(3):215-20. DOI:10.4103/0971-5851.142038
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ABSTRACT: To evaluate retrospectively rates of local (LCR) and locoregional tumor control (LRCR) in patients with locally advanced breast cancer (LABC) who were treated with preoperative chemotherapy (PST) followed by breast conserving surgery (BCS) and either intraoperative radiotherapy with electrons (IOERT) preceding whole breast irradiation (WBI) (group 1) or with WBI followed by an external tumorbed boost (electrons or photons) instead of IOERT (group 2). From 2002 to 2007, 83 patients with clinical stage II or III breast cancer were enrolled in group one and 26 in group two. All patients received PST followed by BCS and axillary lymph node dissection. IOERT boosts were applied by single doses of 9 Gy (90% reference isodose), versus external boosts of 12 Gy (median dose, range 6 – 16) in 2 Gy/fraction (ICRU). WBI in both groups was performed up to total doses of 51 - 57 Gy (1.7- 1.8 Gy/fraction).The respective median follow-up times for groups one and two amount 59 months (range 3 – 115) and 67.5 months (range 13 - 120). Corresponding 6-year rates for LCR, LRCR, metastases free survival (FFM), disease specific survival (DSS), and overall survival (OS) were 98.5%, 97.2%, 84.7%, 89.2% and 86.4% for group one and 88.1%, 88.1%, 74%, 92% and 92% for group two, respectively, without any statistical significances. IOERT as boost modality during BCS in LABC following PST shows a trend to be superior in terms of LCR and LRCR in comparison with conventional boosts. © 2014 Wiley Periodicals, Inc.International Journal of Cancer 07/2014; DOI:10.1002/ijc.29064 · 5.01 Impact Factor