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.
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ABSTRACT: Breast conservation surgery after large volume excisions for women with relatively larger or multicentric operable breast cancer (OBC) and in some locally advanced breast cancers (LABC) post neo-adjuvant chemotherapy (NACT), is known to be a feasible option using a latissimus dorsi flap. However, the oncological safety of such a procedure is not well reported in literature. Two hundred and twenty one women with breast cancer (148-OBC, 73-LABC) underwent BCT plus LD during March 1998 to August 2009. One hundred and forty six women (72-LABC, 66-OBC) received prior NACT for downstaging, followed by completion of adjuvant therapy in all, including postoperative radiotherapy and hormone therapy where indicated. Women aged 20-62 years, with tumors 1.5-15 cm (median 5.0 cm), underwent volume replacement surgery with LD flap. All positive cut margins (total-4.9%, gross positive-1.3%) were re-excised to ensure negative margins. The mean surgical time for excision of primary with axillary clearance followed by volume replacement by LD was 5 h and mean hospital stay 6 days. Donor site morbidity was seen in 11 patients and 3 had minor recipient site infection. At a median follow up of 36 months, ten of 221 patients (4.5%) had failed locally (7-OBC, 3-LABC). The determinants of local recurrence were presence of lymphatic vascular invasion (p = 0.016) and axillary metastasis (p = 0.003). BCT plus LD flap is an oncologically safe, technically quick procedure with minimal morbidity, and should be offered to all eligible women as an extended breast conservation procedure.Indian journal of surgical oncology. 09/2010; 1(3):256-62.
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ABSTRACT: The optimal surgical management of locally advanced breast cancer (LABC) remains undefined. The aim of the study was to obtain long-term results of oncoplastic surgery in terms of overall survival, loco-regional recurrence, and quality of life in case of LABC. Prospective cohort study enrolled 60 patients with stage III breast cancer. Forty-two (70%) patients received neo-adjuvant chemotherapy, 28 patients were considered suitable for surgery as initial treatment option. Type II oncoplastic surgery was performed for all patients: hemimastectomy and breast reconstruction with latissimus dorsi flap - for 29 (48.3%), lumpectomy - 31 (51.7%), and reconstruction with subaxillary flap for four (6.7%), with bilateral reduction mammoplasty - 14 (23.3%) and with J-plastic - 13 (21.7%) patients. Adjuvant chemotherapy and hormonal therapy followed surgery for all, except one, patients. Sequential radiotherapy was administered for all patients. The mean period of follow-up was 86 months. Postoperative morbidity rate was 5%. Local-regional recurrence was detected in six (10%) patients. After reoperation no local relapse was diagnosed. However, three of these patients had systemic dissemination of the disease. Distant metastasis was detected in 23 (38.3%) patients. Distant metastasis-free survival at 5 years was 61.7%. Fourteen patients died (23.3%). A total of 87.2% of the patients had good and excellent esthetic outcome. Oncoplastic breast-conserving surgery can be proposed for selected patients with LABC with acceptable complication, local recurrence rate, and good esthetic results.The Breast Journal 11/2013; · 1.83 Impact Factor
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ABSTRACT: Limited guidelines exist for breast cancer management in developing countries. In this context, the Women's Cancer Initiative - Tata Memorial Hospital (WCI-TMH) organised its 8(th) Annual Conference to update guidelines in breast cancer. Appropriately formulated guideline questions on each topic and subtopic in the surgical, radiation and systemic management of primary breast cancer were developed by the scientific committee and shared with the guest faculty of the Conference. Majority of the questions had multiple choice answers. The opinion of the audience, comprising academic and community oncologists, was electronically cumulated, followed by focussed presentations by eminent national and international experts on each topic. The guidelines were finally developed through an expert panel that voted on each guideline question after all talks had been delivered and audience opinion elicited. Separate panels were constituted for locoregional and systemic therapy in primary breast cancer. Based on the voting results of the expert panel, guidelines for locoregional therapy of breast cancer have been formulated. Voting patterns for each question are reported. The updated guidelines on locoregional management of primary breast cancer in the context of developing countries are presented in this article. These recommendations have been designed to allow centers in the developing world to improve the quality of care for breast cancer patients.Indian journal of medical and paediatric oncology 04/2012; 33(2):112-22.