1043 Surgical aspects of induction chemotherapy in stage II-III breast cancer

Abstract

The issue considered is whether surgery is affected by induction chemotherapy in stage II-III breast cancer. This aspect of breast cancer management has not until now been totally clarified and therefore has taken the attention of our study group, particularly with regard to peri-operative morbidity. Sixty patients with locally advanced/innammatory breast cancer or large T2 N0-1 tumor treated by induction chemotherapy have been evaluated: at the time of diagnosis, 20 cases were in stage IIIB (inflammatory), 23 in stage IIIA/IIIB (non-inflammatory), and 17 cases in stage IIA/IIB. Induction chemotherapy schedule was: CMF (<i>Ctx 150</i><i>mg\d days 1–14; Mtx 40</i><i>mg/m</i>² <i>days 1, 8; 5-Fu 600 mg/m</i>² <i>days 1, 8</i>) as first cycle, Adriamycin (<i>75</i><i>mg/m</i>² <i>day 1</i>) as second, and CMF as last cycle. The local response to therapy-allowed breast conservation in 12 cases (20%) (4 in stage HIII/IIIB and 8 in stage IIA/IIB). Mastectomy was required in 48 patients (80%) (20 in stage IIIB, 19 in stage IIIA/IIIB, and 9 in stage IIA/IIB), in 6 cases associated with immediate breast reconstruction, and in one case with full-thickness chest wall resection and prosthetic reconstruction. Surgery was performed 4 to 6 weeks after the last cycle of chemotherapy. Chemotherapy was then continued for a total of 6 cycles. All patients underwent postoperative radiotherapy on the chest wall or whole breast depending on the surgical procedure. There was no operative mortality. Perioperative morbidity was observed in 11 patients (18%): neutropenia that delayed surgery in 5 cases (8%); wound infection with delayed healing in 2 cases (3%); seroma in 3 cases (5%); partial necrosis of cutaneous flap in one case (1.5%); pneumonia and pleural effusion in one case (1.5%). No upper extremity lymphedema was observed. Complications were easily managed in all cases, determined only a slight increase of hospitalization and generally did not delay postoperative therapy. The 60 patients who underwent induction chemotherapy were compared with 60 patients treated directly by surgery. The two groups were matched according to age, type of surgery and time of operation. No significant difference (<i>P</i>=0.077) was found between the two groups in the incidence of postsurgical complications. As a conclusion, in our series induction chemotherapy did not seem to influence the outeome of surgery in terms of perioperative morbidity.