P0103 Results of breast conserving surgery in locally advanced breast cancer following neoadjuvant chemotherapy

Abstract

Background Locally advanced breast cancer (LABC) includes patients with large tumours, extensive regional lymph node involvement, and direct involvement of the skin or underlying chest wall. Neoadjuvant chemotherapy followed by surgery, with adjuvant radiotherapy and hormonal therapy, has become the standard of care and a valuable strategy in the multimodal management of LABC. Methods This single institution, retrospective cohort study was done at Tata Medical Center for patients operated after neoadjuvant chemotherapy for LABC between November 2012 and August 2013. Eighty-nine women (30% of total breast surgeries) had undergone surgery after neoadjuvant chemotherapy during this period. Anthracycline-based chemotherapy regimens (FECx6 or FEC-Tx6) were always completed before surgery. All patients had adjuvant radiotherapy, with endocrine therapy if appropriate. Median follow up is 9 months. Findings Twenty-seven women requested breast conservation but at presentation had tumours too large. Conservation was possible in 24 women (three with volume replacement). Three others had mastectomy (two with immediate reconstruction). One had a second excision for close margins. Sixty-two women had fungating, inoperable or multi-quadrant tumours, necessitating mastectomy. Overall 26% of patients had a complete pathological response (23% in mastectomy and 37.5% in breast conserving surgery groups, chi-square 1.85, p = 0.17). Of the mastectomy patients, 18% had early lymphoedema. No lymphoedema was seen after breast conserving surgery (chi-square 4.1, p = 0.04). Local recurrence occurred in 6% of women following mastectomy, all in patients presenting with T4 disease. No local recurrence was seen after breast conserving surgery. Interpretation Neoadjuvant chemotherapy converts patients initially ineligible for breast conserving surgery into candidates for such surgery. We believe that the key to the successful breast conserving surgery after neoadjuvant chemotherapy is careful patient selection and coordination among specialties.