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Oncologic safety of breast conserving surgery after tumour downsizing by neoadjuvant therapy: a retrospective single centre cohort study

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Abstract

The objective of this study is to analyse local recurrence rates in patients receiving neoadjuvant chemotherapy (nCT) comparing mastecomized (MX) patients with those undergoing breast conserving therapy (BCT). Patients undergoing breast cancer surgery after nCT (3xCMF or 3-6xED) between 1995 and 2007 at our department were retrospectively analysed. The median follow up was 60 months for 308 patients. Patients who were downsized from MX to BCT with partial or complete response (n = 104) had a similar local recurrence free survival (LRFS) compared to patients who did not experience successful downsizing (n = 67) and finally undergoing MX (LRFS MX-BCT 81% vs. MX-MX 91%; P = 0.79). Uni- and multivariate analyses demonstrated that BCT itself was not an independent prognostic factor for a worse LRFS (P = 0.07 and 0.14). After no pathologic change or progressive disease the risk of local recurrence was increased in patients undergoing BCT (MX-BCT; n = 6 LRFS 66%) compared with MX (n = 44; LRFS 90%; P = 0.04). Overall survival in general was better for the BCT group (n = 197) compared with MX group (n = 111) regardless of clinical response (92% vs. 72%; P < 0.0001). Breast conservation, nodal negativity and low or medium grade histology were prognostic factors for an improved OS (P = 0.02, 0.01, 0.004). In conclusion, our study suggests that BCT is oncologically safe after tumour downsizing by nCT in patients primarily scheduled for mastectomy. These patients, however, should not be treated with breast conservation in the absence of any proven response after nCT.

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References

  1. Mauri D, Pavlidis N, Ioannidis JP (2005) Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst 97:188–194

    Article  PubMed  Google Scholar 

  2. Mieog JS, van der Hage JA, van de Velde CJ (2007) Neoadjuvant chemotherapy for operable breast cancer. Br J Surg 94:1189–1200

    Article  PubMed  CAS  Google Scholar 

  3. Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493

    PubMed  CAS  Google Scholar 

  4. Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, Wickerham DL, Begovic M, DeCillis A, Robidoux A, Margolese RG, Cruz AB Jr, Hoehn JL, Lees AW, Dimitrov NV, Bear HD (1998) Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16:2672–2685

    PubMed  CAS  Google Scholar 

  5. van der Hage JA, van de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L (2001) Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 19:4224–4237

    PubMed  Google Scholar 

  6. Steger G, Kubista E, Hausmaninger H, Gnant M, Tausch C, Lang A, Samonigg H, Galid A, Jakesz R (2004) 6 vs. 3 Cycles of epirubicin/docetaxel + G-CSF in operable breast cancer: results of ABCSG-14. J Clin Oncol 22:553

    Google Scholar 

  7. Steger GG, Greil R, Jakesz R, Lang A, Mlineritsch B, Melbinger-Zeinitzer E, Marth C, Samonigg H, Kubista E, Gnant M (2009) A randomized phase III study comparing epirubicin, doxetacel, and capecitabine (EDC) to epirubicin and docetaxel (ED) as neoadjuvant treatment for early breast cancer—first results of the ABCSG Trial 24. In: ESMO 2009. Berlin

  8. Taucher S, Steger GG, Jakesz R, Tausch C, Wette V, Schippinger W, Kwasny W, Reiner G, Greil R, Dubsky P, Poestlberger S, Tschmelitsch J, Samonigg H, Gnant M (2008) The potential risk of neoadjuvant chemotherapy in breast cancer patients—results from a prospective randomized trial of the Austrian Breast and Colorectal Cancer Study Group (ABCSG-07). Breast Cancer Res Treat 112:309–316

    Article  PubMed  CAS  Google Scholar 

  9. Loibl S, von Minckwitz G, Raab G, Blohmer JU, Dan Costa S, Gerber B, Eidtmann H, Petrich S, Hilfrich J, Jackisch C, du Bois A, Kaufmann M (2006) Surgical procedures after neoadjuvant chemotherapy in operable breast cancer: results of the GEPARDUO trial. Ann Surg Oncol 13:1434–1442

    Article  PubMed  Google Scholar 

  10. Riedl O, Fitzal F, Mader N, Dubsky P, Rudas M, Mittlboeck M, Gnant M, Jakesz R (2008) Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol 35:264–270

    PubMed  Google Scholar 

  11. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B (2001) 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 30:96–102

    PubMed  Google Scholar 

  12. CG EBCT (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366:2087–2106

    Google Scholar 

  13. Broet P, Scholl SM, de la Rochefordiere A, Fourquet A, Moreau T, De Rycke Y, Asselain B, Pouillart P (1999) Short and long-term effects on survival in breast cancer patients treated by primary chemotherapy: an updated analysis of a randomized trial. Breast Cancer Res Treat 58:151–156

    Article  PubMed  CAS  Google Scholar 

  14. Mauriac L, MacGrogan G, Avril A, Durand M, Floquet A, Debled M, Dilhuydy JM, Bonichon F (1999) Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS). Ann Oncol 10:47–52

    Article  PubMed  CAS  Google Scholar 

  15. Buchholz TA, Lehman CD, Harris JR, Pockaj BA, Khouri N, Hylton NF, Miller MJ, Whelan T, Pierce LJ, Esserman LJ, Newman LA, Smith BL, Bear HD, Mamounas EP (2008) Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference. J Clin Oncol 26:791–797

    Article  PubMed  Google Scholar 

  16. Kaufmann M, von Minckwitz G, Bear HD, Buzdar A, McGale P, Bonnefoi H, Colleoni M, Denkert C, Eiermann W, Jackesz R, Makris A, Miller W, Pierga JY, Semiglazov V, Schneeweiss A, Souchon R, Stearns V, Untch M, Loibl S (2007) Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol 18:1927–1934

    Article  PubMed  CAS  Google Scholar 

  17. von Minckwitz G (2008) Preoperative therapy: what, when and for whom? Ann Oncol 19(Suppl 5):v113–v116

    Article  Google Scholar 

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Acknowledgments

Florian Fitzal is independent of any commercial funder and he had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The author thanks Karl Thomanek for English revision and Natalija Frank for her dedicated work with the patients and the data base.

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Authors and Affiliations

  1. Department of Surgery, Breast Health Center, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria

    F. Fitzal, O. Riedl, P. Dubsky, R. Jakesz & M. Gnant

  2. Department of Biometrics, Medical University Vienna, Vienna, Austria

    M. Mittlböck

  3. Department of Medical Oncology, Medical University Vienna, Vienna, Austria

    R. Bartsch & G. Steger

Authors
  1. F. Fitzal
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  2. O. Riedl
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  3. M. Mittlböck
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  4. P. Dubsky
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  5. R. Bartsch
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  6. G. Steger
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  7. R. Jakesz
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  8. M. Gnant
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Corresponding author

Correspondence to F. Fitzal.

Additional information

Presented at the EBCC7 meeting in Barcelona 24th–27th March 2010 and published as abstract in Eur J Cancer.

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Fitzal, F., Riedl, O., Mittlböck, M. et al. Oncologic safety of breast conserving surgery after tumour downsizing by neoadjuvant therapy: a retrospective single centre cohort study. Breast Cancer Res Treat 127, 121–128 (2011). https://doi.org/10.1007/s10549-010-1164-9

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  • DOI: https://doi.org/10.1007/s10549-010-1164-9

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