P3-13-08: Survival Analysis and Recurrence Patterns in Locally Advanced Breast Cancer Following Neoadjuvant Chemotherapy and Preoperative Concurrent Chemo Radiotherapy.

Abstract

Abstract Introduction: Although not widely used, preoperative concurrent chemo radiotherapy (CCRth) following poor response to neo adjuvant chemotherapy (CT) has been recently associated with an improved prognosis in patients with locally advanced breast cancer (LABC) and high recurrence risk, showing acceptable toxicity profiles, acceptable post surgical complication rates and increases in both clinical and pathologic response rates and local control rates. The objective of this study was to assess disease free survival (DFS), overall survival (OS) and patterns of recurrence in a cohort of patients with LABC treated with pre operative CCRth following poor response to neo adjuvant CT. Methods: This longitudinal study included a total of 287 patients with LABC treated with pre operative CCRth following poor response to neo adjuvant CT between February 2000 and December 2002. Demographic, clinical/pathologic, therapeutic and follow up data were collected from patient charts to determine DFS, OS and recurrence patterns. Results: Stages IIB, IIIA and IIIB accounted for 22.3, 37.6 and 40% of the population, respectively. Clinical response rates compared to pathologic response rates following anthracyline based CT and CCRth were minimal or stable in 16% vs 62.4%, partial in 53 vs 76.3% and complete in 30 vs 23.3%. No significant treatment related toxicities were identified. Post surgical complications included flap ischemia in 16%, partial flap necrosis in 18%, both ischemia and partial flap necrosis in 13.2% and partial wound dehiscence in 7.7%. With an average follow up of 64.1 ± 37.2 months, (0-126.3 months), 36.9% of the population relapsed and 55.1% remained disease free. With regard to recurrence patterns, 22.6% presented loco regional relapse, 67.7% recurred at a distant site and 9.8% showed presented both. Median OS was 64.2 months (0-126 months). Five and ten year survival probability was shown to be 75% and 60%, respectively. Conclusions Despite improvements in local control rates and overall outcomes with current therapeutic regimens combining chemotherapy, surgery, and radiotherapy, 30 to 40% of patients with locally advanced breast cancer develop post treatment loco regional recurrence and 5 year overall survival remains low (50%). Multimodal treatment integrating pre operative CCRth is therefore a valid alternative in the LABC setting, showing promising results in regard to OS, DFS and recurrence rates. Prospective clinical studies to evaluate its use are warranted. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-08.