Article

Breast conservation treatment in women with locally advanced breast cancer - experience from a single centre.

Breast Service, Breast Group, Tata Memorial Hospital, Surgical Oncology, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra 400 012, India.
International Journal of Surgery (London, England) (Impact Factor: 1.44). 01/2006; 4(2):106-14. DOI: 10.1016/j.ijsu.2006.01.004
Source: PubMed

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.

0 Bookmarks
 · 
81 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    Indian journal of medical and paediatric oncology 07/2014; 35(3):215-20.
  • [Show abstract] [Hide abstract]
    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; · 1.43 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 6.20 Impact Factor