Primary Surgery Compared to Post Chemotherapy Surgery for Patients with Locally Advanced Breast Cancer

Ibrahim Altedlawi Albalawi

doi:10.4236/jct.2018.910064

Abstract

Purpose: To compare primary surgery and surgery after neoadjuvant chemotherapy (NCT) in locally advanced breast cancer (LABC) patients. Methods: Between January 2011 & December 2015, 112 patients with LABC were treated at KAAH & OC-Jeddah-KSA, Of whom 42 were treated by NCT followed by surgery either mastectomy or conservative surgery, then adjuvant chemotherapy and radiotherapy. The rest patients (70) were treated by primary surgery (mastectomy or conservative resection) and followed by adjuvant chemotherapy and radiotherapy. All patients received adjuvant antiestrogen. Patients were followed for a median duration of 33 months. Disease-free survival (DFS) and overall survival (OAS) were studied for all patients, compared between both groups and related to the extent of surgery and menopausal status. Results: median age was 46.5 years for all patients; 48 years, and 46 years for NCT and primary surgery groups respectively. Median DFS was 15 months for all patients, 16 & 15 months for NCT and primary surgery groups. Median OAS was 24 months for all patients, 22 & 24 months for NCT and primary surgery groups. Difference in DFS & OAS were highly significant in favour of postmenopausal patients (p = 0.05 for DFS & p = 0.03 for OAS) while in primary surgery group the differences between pre and postmenopausal patients in DFS & OAS were statistically insignificant (p = 0.4). NCT followed by surgery group patients showed significant improvement in DFS & OAS in patients performed conservative surgery while in primary surgery group the difference was insignificant. Freedom of disease was seen in 28.6% in the NCT group and 37.1% for the primary surgery group. Conclusion: Surgery post-neoadjuvant chemotherapy neither prolongs DFS nor OAS in comparison with primary surgery followed by adjuvant chemotherapy. Postmenopausal patients felt much better than premenopausal patients regarding DFS & OAS.

Highlights

IntroductionAdvanced breast carcinoma (LABC) comprises a heterogeneous group of tumors ranging from relatively large primary tumors (stage T4) to small breast tumors presenting with extensive nodal metastases (involvement of ipsilateral, infraclavicular, supraclavicular, or internal mammary nodes)
Advanced breast carcinoma (LABC) comprises a heterogeneous group of tumors ranging from relatively large primary tumors to small breast tumors presenting with extensive nodal metastases
Between January 2011 & December 2015, 112 patients with locally advanced breast cancer (LABC) were treated at KAAH & OC-Jeddah-KSA, Of whom 42 were treated by neoadjuvant chemotherapy (NCT) followed by surgery either mastectomy or conservative surgery, adjuvant chemotherapy and radiotherapy

Summary

Introduction

Advanced breast carcinoma (LABC) comprises a heterogeneous group of tumors ranging from relatively large primary tumors (stage T4) to small breast tumors presenting with extensive nodal metastases (involvement of ipsilateral, infraclavicular, supraclavicular, or internal mammary nodes). It remains a clinical challenge as the majority of patients with this diagnosis develop distant metastases despite appropriate therapy [1] [2]; inflammatory carcinomas included in locally advanced breast carcinoma [3]. The introduction of multimodality treatment with the addition of chemotherapy has resulted in improvement of disease-free survival in stage IIIA [4] [7]

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