Abstract
Simple SummaryThe originality of this prospective study is to use radiation therapy in association with chemotherapy before surgery and permit patients to preserve their breasts or to undergo immediate reconstruction. This neoadjuvant strategy can therefore allow one-stage breast reconstructive surgery, the so-called “reverse technique”.Background: Neoadjuvant concurrent radiochemotherapy makes it possible to increase the breast conservation rate. This study reports the long term outcome of this treatment. Methods: From 2001 to 2003, 59 women with T2–3 N0–2 M0 invasive breast cancer (BC) not amenable to upfront breast conserving treatment (BCS) were included in this prospective, non-randomized phase II study. Chemotherapy (CT) consisted of four cycles of continuous 5-FU infusion and Vinorelbine. Starting concurrently with the second CT cycle, normofractionated RT was delivered to the breast and LN. Breast surgery was then performed. Results: Median follow-up (FU) was 13 years [3–18]. BCS was performed in 41 (69%) patients and mastectomy in 18 patients, with pathological complete response rate of 27%. Overall and distant-disease free survivals rates at 13 years were 70.9% [95% CI 59.6–84.2] and 71.5% [95% CI 60.5–84.5] respectively. Loco regional and local controls rates were 83.4% [95% CI 73.2–95.0] and 92.1% [95% CI 83.7–100], respectively. Late toxicity (CTCAE-V3) was assessed in 51 patients (86%) with a median follow-up of 13 years. Fifteen presented grade 2 fibrosis (29.4%), 8 (15.7%) had telangiectasia, and 1 had radiodermatitis. Conclusions: This combined treatment provided high long-term local control rates with limited side-effects.
Highlights
The standard treatment for localized breast cancer is lumpectomy followed by radiotherapy to the breast possibly combined with a boost to the tumour bed, or mastectomy when a large tumour prevents breast-conserving treatment
Patients between the ages of 18 and 65 years had to present a good general condition compatible with concomitant chemoradiotherapy
Positive diagnosis and staging were based on physical examination, mammogram and bilateral ultrasound, bilateral breast magnetic resonance imaging (MRI), core biopsy, and a standard radiological work-up looking for distant metastases
Summary
The standard treatment for localized breast cancer is lumpectomy followed by radiotherapy to the breast possibly combined with a boost to the tumour bed, or mastectomy when a large tumour prevents breast-conserving treatment This strategy reduces the risk of local recurrence and improves the patient’s overall survival [1,2]. In patients who are not eligible for first-line breast-conserving surgery, neoadjuvant chemotherapy has been shown to be effective in terms of downstaging, but to a lesser extent in hormone receptor-positive patients [4]. This neoadjuvant strategy can allow one-stage breast reconstructive surgery, the so-called “reverse technique”. We report the 13-year results of trial S14 in terms of long-term toxicities and survival to evaluate these long-term results in the context of modern individualized treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
