Conserving Surgery Rate Research Articles

Abstract P4-14-03: Preoperative carboplatin-paclitaxel-bevacizumab in triple negative breast cancer: Final results of the phase II CA.Pa.Be study

Abstract Introduction: Management of triple negative breast cancer (TNBC) is still a major challenge: a significant proportion patients relapse despite adjuvant chemotherapy, and the median survival from relapse rarely exceeds 1 year. Angiogenesis activation as well as impairment in mechanisms of DNA repair are frequently described in sporadic TNBCs, but the role of angiogenesis inhibitors and platinum salts is still controversial. This is a phase II trial of preoperative carboplatin-paclitaxel in combination with bevacizumab in TNBC patients with previously untreated, stage II-III disease. The primary aim of the study is the pathologic complete response (pCR) rate. Among the secondary aims: safety, breast conserving surgery rate, early response assessment with dynamic contrast-enhanced Magnetic Resonance Imaging (DCE-MRI), biomarker analyses. Methods: Patients with hormone receptor negative (ER and PgR <1%), HER2 negative stage II-III breast cancer are eligible. At baseline, patients undergo breast DCE-MRI, followed by a single dose of bevacizumab 5 mg/kg (day -7). DCE-MRI is repeated prior to start chemotherapy (CT). On day 1, patients start CT with paclitaxel 80 mg/sqm+carboplatin AUC2 on days 1,8, 15 q 28, combined with bevacizumab 10 mg/kg on days 1 and 15. Patients received 5 preoperative cycles and undergo surgery within 6 weeks from the last CT course. Bevacizumab is omitted on cycle 5, to minimize the risk of surgical complications. Tissue samples are centralized to evaluate treatment effect on several tissue markers, as well as to identify potential predictors of treatment benefit. The sample size is estimated with the two-stage Simon's design, on the basis of a 40% expected pCR rate. A total of 43 patients are required, with the combination deemed worthwhile in case of at least 13 pCRs. Results: the accrual of the 44 planned patients is completed. Patients characteristics were as follows: median age 46 yrs (29-74); clinical stage IIA: 38.2%, IIB: 35.3%, III: 26.5%; ductal histology: 89%; histologic grade 3: 95%. Notably, 59% of the patients had clinically involved axillary nodes. At present, 33 patients are assessable for toxicity. Bevacizumab-associated adverse events (AEs) were mild: grade 1-2 hypertension occurred in 3 patients (9%) and grade 1 bleeding in 9 patients (27%). No grade 4 non-hematologic AEs were recorded; Grade 3 AEs were: liver function tests abnormalities in 3 patients, diarrhea in 3 patients, and neuropathy in 1 patient. Thirty-one patients underwent surgery, 16 patients (51%) received breast conserving surgery. A pCR in breast and axillary lymph-nodes was achieved in 16 patients (51%); 25 patients (81%) had negative axillary nodes (yN0). Conclusions: No unexpected toxicity was observed by combining bevacizumab to neoadjuvant platinum-taxane based CT. This combination is active in TNBCs, and the rate of pCR is in the expected range. Moreover, 80% of the patients have nodal negativity at surgery, and these results are of particular interest taking into account the high proportion of patients with clinically involved nodes at the time of diagnosis. The final results along with biomarkers data and early response assessment with DCE-MRI will be available at the time of the meeting. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-14-03.

N-SAS BC06: A phase III study of adjuvant endocrine therapy with or without chemotherapy for postmenopausal breast cancer patients who responded to neoadjuvant letrozole (LET): The New Primary Endocrine-Therapy Origination Study (NEOS).

TPS654 Background: It is uncertain whether adjuvant chemotherapy is required in the treatment of postmenopausal women with hormone-responsive and intermediate risk breast cancer. The TAILORx and MINDACT trials are ongoing and utilize gene expression profiling in order to answer this question. We have initiated a new study to address this matter by using response to initial neoadjuvant endocrine therapy. The primary aim of this phase III study is to evaluate the necessity of using adjuvant chemotherapy for the treatment of postmenopausal breast cancer patients with node-negative, ER-positive and HER2-negative tumors who responded to neoadjuvant LET. Methods: Inclusion criteria are T1c-T2N0M0, ER-positive by IHC (<10%), HER2-negative, postmenopausal women under 75 years old and written informed consent. Lymph node positive patients as assessed by SLNB are excluded. Neoadjuvant LET is administered for 24-28 weeks before surgery. CR, PR or SD patients are then randomized into two arms receiving either chemotherapy plus LET for 4.5-5 years or LET alone for 4.5-5 years after surgery. If the primary tumor response is defined as PD before surgery, the treatment will be changed at the investigator's discretion (surgery, chemotherapy or other endocrine therapy, but these patients will be followed up). The primary endpoint is disease-free survival (DFS), and secondary endpoints are overall survival (OS), response rate of LET, pathological response, breast conserving surgery rate, DFS/OS by response rate of LET, safety, QOL and cost-effectiveness. This study utilizes a randomized selection design. The objective of this design is to select the arm with the better outcome. We also conduct an additional translational research and central pathological review of ER, PgR, HER2, and Ki67.Patient recruitment commenced in May 2008 and 803 patients were enrolled at the end of 2012. A total of 850 patients will be enrolled at the end of May 2013. This study is supported by Public Health Research Foundation. Clinical trial information: UMIN000001090.

Laparoscopic management of pedicle torsion of adnexal cysts

Pedicle torsion of adnexal cysts results from the increased weight of cysts, longer length of the ovarian and suspensory ligaments or ovarian teratoma. Color doppler ultrasonography is particularly important for detecting suspected cyst torsion. Laparoscopy is becoming more important in the early diagnosis and treatment of adnexal cyst torsion due to its advantages, such as its minimally invasive nature, reduced acute stress reaction and facilitation of direct observation of intra-abdominal lesions. The present study analyzed 28 cases of laparoscopic torsion surgery. The laparoscopic conservative surgery rate was 75% and loss of endocrine function and fertility was avoided. Since the torsion duration is the only variable factor for avoiding oophorectomy, laparoscopic exploration should be performed as soon as possible when pedicle torsion of an adnexal cyst is suspected. Detorsion while retaining ovarian function did not increase the risk of thromboembolism and laparoscopic surgery was minimally invasive with faster recovery times and minimal impact on fertility. Furthermore, the study showed that the laparoscopic management of pedicle torsion of adnexal cysts is safe and reliable with the retention of ovarian endocrine and reproductive function.

A retrospective outcome study in the elder patient with locally advanced rectal cancer treated with hypofractionated or conventional preoperative radiotherapy

Background: Neoadjuvant chemoradiotherapy is considered the standard approach for T3-4 M0 rectal cancer; however, the optimal dose remains undefined for the elderly. We performed a retrospective analysis to compare conventional (C) and hypofractionated (HF) schedules in elderly patients. We compared survival rates, local control and morbidity. Methods: From 2000 to 2008, 177 patients older than 65 years with T3-4 M0 rectal cancer received preoperative radiotherapy according to either a conventional protocol (45 to 50.4 Gy in 1.8-2 Gy daily fractions) or a hypofractionated (39 Gy in 3 Gy daily fractions) protocol. Fifty-five patients in the conventional group and none of the patients in the hypofractionated group received concomitant chemotherapy. Both groups were equivalent in terms of their characteristics. The median follow-up was 36 months. Results: The occurrence of early grade 3-4 radiation toxicity was equivalent between the 2 groups (7%). Surgery was performed in 98% of the patients in the HF group versus 92% in the conventional ( p =0.08). The delay between radiotherapy and surgery was 22 days in the HF group versus 45 days in the conventional group ( p =0.0021). The downstaging rates were 39% in HF group and 45% in the C group ( p =0.53). For lower rectum tumors, the conservative surgery rates were 43% in the HF group and 35% in the C group, ( p =0.52). The postoperative death rates at 30 days were equal between the two groups (3%). The 5-year local control rates was 87.3% in group C and 91.7% in group HF ( p =0.5). Based on a Kaplan-Meier analysis, the 1-, 3- and 5-year overall survival rates were 88%, 67% and 45%, respectively, in the C group and 84%, 60% and 39%, respectively, in the HF group ( p =0.28). In a multivariate analysis, the prognostic factors for overall survival were a Charlson index < 2 ( p =0.0034 HR=0.3), pT stage ≤2 ( p =0.0042 HR=0.16), pN0 stage ( p =0.0072 HR=0.388), and downstaging ( p =0.0498 HR=0.651). Radiation schedule and concomitant chemotherapy had no impact. Conclusion: In this series, the local control rates and the overall survival results are equivalent for patients treated with HP and C radiation schedules. As hypofractionated radiotherapy is more convenient for elderly patients and has equivalent morbidity, additional prospective studies with this population could be of great interest.

Abstract P5-11-01: Extending breast conservation choices for women with breast cancer

Abstract Introduction: Long term outcomes for women treated with breast conserving surgery are similar to women having mastectomy. The adoption of modern oncoplastic techniques (e.g. volume displacement) has increased the proportion of women having breast conserving surgery compared with mastectomy. The widespread use of therapeutic reduction mammoplasty (TRM) can further reduce the need for mastectomy in a modern oncoplastic breast unit. We analyse if the introduction of TRM has led to an increase in breast conservation and more choice for women treated at our unit. Methods: Operative logbooks were reviewed. The two-year period April 2007 - April 2009 (before widespread adoption of TRM) was compared to April 2010 - April 2012. Length of stay, re-admission rates, additional operative procedures and cancer recurrences were analysed. Results: During the 2007–2009 time period, a single surgeon undertook 209 primary operations for breast cancer. 64 women underwent mastectomy (30.6%). Of these, 26 (40.6%)had an immediate reconstruction with latissimus dorsi flap (+/− an implant). 4 women in this period had a TRM as their primary surgery for breast cancer (1.9%). During the 2010–2012 period, the same surgeon undertook 201 primary operations for breast cancer. 55 women underwent mastectomy (27.4%): 27 had immediate latissimus dorsi reconstruction; 13 had implant based reconstruction (overall reconstruction rate 72%). 32 patients underwent TRM as their primary breast cancer operation (15.9%), all with simultaneous contralateral breast reduction. Of the immediate reconstruction group in 2007–09, 11 women (42%) have undergone another operative procedure – nipple reconstruction, contralateral breast operations, capsulectomy or “tidying-up” procedures. One patient has had a recurrence of her breast cancer and one patient has died of breast cancer in the 5 year follow-up period. One patient has developed contralateral breast cancer. In the 2010–12 TRM group, 6 patients (18.8%) underwent a second operation – 3 re-excisions of positive margins and 3 axillary clearances (positive sentinel lymph node biopsy at first operation). The median length of stay for women treated with TRM was 1 day compared to a median stay of 6 days for patients undergoing latissimus dorsi reconstruction. Conclusions: Our unit already had high breast conserving surgery rates and a high reconstruction:mastectomy ratio. Introduction of TRM became widespread approximately 2 years ago. Using a TRM technique 25–50% of the breast volume can be removed. This enables some patients who would have been advised mastectomy to be offered a choice of breast conserving surgery; hence the further modest reduction in mastectomy rate seen. TRM enables breast (and nipple) conservation and a quicker recovery period. TRM may appeal to women thinking about breast reduction before a breast cancer diagnosis. It is useful after neoadjuvant treatment, for multifocal tumours and in women where a high tumour volume:breast volume ratio would make good cosmetic results difficult to achieve with traditional breast conservation techniques. A further advantage of TRM is the simultaneous contralateral breast reduction; thus reducing re-operation rates. In conclusion, most importantly, TRM extends breast conserving surgery choices for women with breast cancer. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-11-01.

PO69 The rate of mastectomies and breast conservative surgery in young women with breast cancer in Albania

PO69 The rate of mastectomies and breast conservative surgery in young women with breast cancer in Albania

Neoadjuvant Chemotherapy in Patients With Locally Advanced Breast Cancer. Factors Related to Ipsilateral Breast Recurrence in Patients Submitted to Conservative Surgery

INTRODUCTION: In patients submitted to neoadjuvant chemotherapy (NC), the breast conservative surgery (BCS) rates vary from 37 to 82%, but it occurs in 1.7% to 28% of patients with locally advanced breast cancer (LABC), which constitutes a sub-group of patients. One way to assess the safety of the BCS after NC is by analyzing recurrence rate. The tumor margins, the form of tumor fragmentation after NC and tumor characteristics are the main factors related to Ipsilateral Breast Tumor Recurrence (IBTR). MATERIAL AND METHODS: A retrospective study approved by the Ethics committee (112/2007) evaluating patients with LABC who were seen in the period from 01/2006 10/2009, and submitted to NC based on 4 cycles of doxorubicin + cyclophosphamide followed by 4 cycles of Docetaxel. BCS was considered when breast or skin was preserved, so this group represents patients submitted to quadrantectomy or skin sparing mastectomy. We evaluated factors related to the IBTR in univariate analysis. RESULTS: A total of 321 patients undergoing chemotherapy, 78 underwent BCS. The age ranged between 21-73 years (median 45.1 years). The clinical tumor size ranged from 1.4 to 9.0 cm (median 5.5 cm). The main histological type was invasive ductal carcinoma (92.3%). There are 6.4% in clinical stage II, 60.3% IIIa, 28.2% IIIb and 5.1% IIIb. Concerning immunohistochemistry expression, 57.7% had estrogen receptor positive, 52.6% progesterone receptor positive and 82.1% HER-2 negative. of the total, 19.2% (15) underwent skin sparing mastectomy and 80.8% quadrantectomy. 2 affected margins (2.6%) were observed. All patients underwent adjuvant radiotherapy and 47.7% to hormonal therapy. Follow-up ranged from 4.5 to 38.4 months (median 19.3 months). At the end of the study 9.0% were alive with disease, 3.8% died from the disease, 2% had lost the follow up, and the others were alive and without disease. The IBTR rate was 9.0%. Local recurrences were more frequent in patients with estrogen receptor negative (p = 0.02), progesterone receptor negative (p = 0.02), EC IIIA (p = 0.50), pT3 (p = 0.73), submitted to quadrantectomy (p = 0.62). The margin (p=0.78) did not influence the recurrence rate. Discussion:Tumor margins and tumor characteristics are the main factors related to IBTR. IBTR occurs 12.7% in patients with clear margins, 15% when the margin is smaller than 15mm and 20.3% positive margins. Besides large tumors and limited follow up, our study was unable to find differences related to margin, because of its low presentation in those cases. IBTR occurs in 0,8% of tumors luminal A and 7,1% of tumors basal-like, but there is no study evaluating that fact in LACB and NC. We observed higher IBTR in the absence of expression of hormonal receptor fact that makes our findings of particular interest. CONCLUSION: The rate of IBTR was acceptable, which justifies this therapy in selected patients. More studies are necessary to evaluate the role of biological characteristics of the tumor and its role in the margin on the LABC.

Expanding the Indications for Breast Conservative Surgery in Locally Advanced Breast Cancer Patients

INTRODUCTION: In patients submitted to neoadjuvant chemotherapy (NC), the breast conservative surgery (BCS) rates vary from 37 to 82%, but it occurs in 1.7% to 28% of patients with locally advanced breast cancer (LABC). New techniques of breast surgery like oncoplastic techniques (OT) and skin-sparing mastectomy (SSM) can security improve the indications of BCS in patients with LABC, but there are limited publications with this kind of patients. MATERIAL AND METHODS: A prospective controlled trial, NCT 00820690 (www.clinical.trials.gov), approved by the Ethics committee (135/2008) evaluated patients with LABC, submitted to NC. Patients with LABC, tumors clinical measured and clinical stage III were eligible for inclusion. Prior to and after the NC the breast was clinically and radiologically evaluated.The surgeons evaluated the possibility of performing BCS before and after the NC. Tumor margin, response to NC, the relationship of tumor size-breast size, comorbidities and desire of the patient were considered for OT evaluation. Skin tattoo was performed in tumor skin projection, which was resected during the surgery. We analyze indications, surgeries performed and safety of BCS, based on margins and local recurrence. RESULTS: According to Consort, 78 patients were enrolled to NC regimen. Invasive ductal carcinoma was present in 93.8% of the tumors. The median tumor size before NC was 6.9 cm (3-14). Based of clinical stage, 61.5% were IIIa, 33.3% IIIb and 5.1% IIIc. 64.0% were submitted to mastectomy, 10.3% quadrantectomies, 15.4% SSM, 7.7% pedicle techniques, 2.6% other OT. All margins were free in patients submitted to quadrantectomy. BCS was performed in 36.0%. Based on pathologic response, 39.7% had concentric tumor decrease, 23.8% tumor fragmentation, 10.3 stable disease, 7.7% progression and 8.9 had complete pathologic response. The median follow up is 19 months (8-40) and 80.8% are alive and free of disease. Local recurrence occurred in 7.7% of the patients, all in patients submitted to mastectomy. DISCUSSION: The surgical planning before and after NC is essential. For safety and oncologic reasons, associated with irregular pathologic response, the resection of all tumor bed area is recommended. CONCLUSION: OT increases the concept of BCS in LABC patients, which improves surgical planning, free margins rate and cosmetic results without increasing local recurrence.

Clinical outcome of preoperative breast MRI for early-stage breast cancer.

42 Background: Preoperative breast magnetic resonance imaging MRI is used in clinical practice to improve oncologic outcome of breast cancer. Concerns over increased rate of unnecessary mastectomies and additional biopsies have been raised. The purpose of our study is to review the outcome of preoperative breast MRI at our institution. Methods: The current study is a retrospective review of 215 patients with early stage breast cancer who underwent definitive surgery. Breast MRI is being used at our institution within the context of multidisciplinary approach. Patients who had complete clinical, radiologic, and pathological data available were identified and formed the basis of this analysis. Results: 215 patients were diagnosed with breast cancer stage I-II in the period of 2006-2012 and had complete data for review. 92 patients out of 215 (43%) had breast MRI prior to definitive surgery. both groups were different in regard of age. Rate of breast conservative surgery, mastectomies, and re-excision for positive margins was similar in both groups. 6 patients out of 12 patients who had breast MRI and underwent bilateral mastectomies were found to have abnormal pathological findings (DCIS 3, LCIS 1, invasive ductal carcinoma 1, and focal epithelial atypia 1). Time from first diagnostic procedure to definitive surgery was similar in both groups (29 days vs. 27.5 days). 38 (41%) patients out of 92 who had breast MRI underwent additional breast biopsies for suspicious lesions with only 8 (21%) patients found to have abnormal pathological findings. Conclusions: Use of breast MRI prior to definitive surgery for early stage breast cancer was associated with increased rate of additional biopsies for suspicious lesions with no favorable effect on re-excision rate. [Table: see text]

An open-label randomized, multicenter, phase II study on neoadjuvant treatment with trastuzumab plus docetaxel versus trastuzumab plus docetaxel plus bevacizumab according to positron emission tomography (PET) value modification in patients with early stage HER2-positive breast cancer (AVATAXHER): Design description.

TPS646 Background: For patients with early HER2+ breast cancer at diagnosis, addition of trastuzumab (T) to 6 cycles of preoperative docetaxel (D) can reach a pathological complete response (pCR) in ~50% of cases, and a high rate of conservative surgery. pCR can be predicted by changes of Fluorodeoxyglucose (FDG) tumor uptake evaluated by Positon Emission Tomography (PET) after one cycle of therapy. In order to increase this pCR rate, adding an antiangiogenic compound could be considered. Pre-clinical and phase I-II data support that the combination of bevacizumab (B) and T is synergistic and safe when patients are chemotherapy naïve. The neoadjuvant AVATAXHER trial (EUDRACT 2009-013410-26) investigates the potential increase of pCR rate by combining B with T and D for patients with HER2+ breast cancer who are not predicted for pCR by FDG PET. Methods: In this multicenter, open-label, phase II trial, 2 phases are planned after a selection period: phase I: all patients receive two cycles of therapy combining T (8 mg/kg at the first cycle, then 6 mg/kg) and D (100 mg/m2). FDG PET is also performed within 7 days before cycle 1 (baseline) and less than 3 days before cycle 2 in order to calculate changes of the tumor FDG uptake between baseline and after cycle 1 (ΔSUV). Phase 2: if ΔSUV≥70%, patients will continue to receive T and D for (cycles 3 to 6: D 100 mg/m2 + T 6 mg/kg); if ΔSUV<70%, patients are randomized 2:1 to arm A (cycles 3 to 6 D 100 mg/m2 + T 6 mg/kg + B 15 mg/kg) or arm B ( cycles 3 to 6: D 100 mg/m2 + T 6 mg/kg). The primary endpoint is pCR rate evaluated post-surgery 4 to 6 weeks after the last treatment of cycle 6. Enrolment began in May 2010 and 125 patients were to be recruited in 26 sites. According to the hypothesis that 60% of patients will have a ΔSUV<70%, it is presumed that 72 patients will be randomized. There are currently 107 patients included (as of 06 January 2012 ), 95 of them reached the phase 1; 52 of them (55%) showed a ΔSUV<70% and after randomization 34 were included in arm A and 18 in arm B.

The Current Role of Endocrine Therapy in Locally Advanced Breast Cancer to Improve Breast Conservation Rates

The use of neoadjuvant therapy is well established in the treatment of the breast cancer, and neoadjuvant endocrine therapy is emerging as a safe and an effective alternative to chemotherapy in selected patients with a hormone receptor–positive locally advanced breast cancer without compromising survival rates. Neoadjuvant endocrine therapy increases the rate of breast conservative surgery in women initially requiring mastectomy, and the latest generation of endocrine therapy, the aromatase inhibitors, has been proved to be superior to tamoxifen. Biomarkers such as Ki67, estrogen receptor, and the PEPI index can be used to select and monitor patients if neoadjuvant endocrine therapy is considered. Biomarkers can give predictive information in weeks, and alternative treatment can be considered before or after surgical resection. The benefits of the neoadjuvant approach are not only tumor size reduction to improve surgical approach, but also to better understand the impact of the treatment on the tumor and treatment resistance due to tumor heterogeneity.

Analysis of clinical and pathological factors related pathologic complete response and local recurrence in patients with locally advanced breast cancer who underwent neoadjuvant chemotherapy.

Locally advanced breast cancer (LABC) is a public health issue in developing countries. Although neoadjuvant chemotherapy (NACT) does not change survival, it allows you to select patients with better prognosis, those with a pathologic complete response (pCR), and increases the rate of conservative surgery as well. Currently, several schemes may be used, but the use of anthracycline-taxane combination therapy has determined pCR in up to 24% of patients. Imaging tests are not sufficient to accurately predict the size of the tumor or the pCR, since there is no uniformity in clinical and anatomopathological (AP) assessment of these tumors. The pathological response is adverse, and there may be fragmentation of the tumor as well as the appearance of residual multifocal lesions. In studies related to NACT, there is no exact description of the methodology used in the preoperative marking of the tumor, and not always the whole tumor area is resected after NACT, and there are no universal criteria for an AP assessment of the surgical specimen, a fact that may influence the findings related to treatment response. There are several factors related to pCR, be them clinical, pathological, expression of markers by immunohistochemistry (IHC) or gene expresion. Keywords: breast neoplasms; drug therapy; neoadjuvant therapy; molecular biology

Quality of Life of Patients Treated with Breast Conserving Surgery and High Dose Rate Interstitial Brachytherapy for Early-stage Breast Cancer

Quality of Life of Patients Treated with Breast Conserving Surgery and High Dose Rate Interstitial Brachytherapy for Early-stage Breast Cancer

Cosmetic Results After Breast Conserving Surgery and High Dose Rate Interstitial Brachytherapy for Early-stage Breast Cancer

Cosmetic Results After Breast Conserving Surgery and High Dose Rate Interstitial Brachytherapy for Early-stage Breast Cancer

Fat Necrosis after Breast Conserving Surgery and High Dose Rate Interstitial Brachytherapy for Early-stage Breast Cancer

Fat Necrosis after Breast Conserving Surgery and High Dose Rate Interstitial Brachytherapy for Early-stage Breast Cancer

What has changed in the management of breast cancer in the past 25 years at the Istanbul University Hospital?

184 Background: There have been important changes in diagnosis and treatment of the breast cancer during the last century. Diagnosing the cancer in early stages brought the new approaches such as breast conserving surgery instead of mastectomy and sentinel lymph node biopsy instead of direct axillary disection. In this study our purpose is to compare the operations which were performed in 1983 and 2008 on breast cancer patients of our clinic and to search the differences in their ages and tumor characteristics. Methods: In each group the files of 100 patients, who were operated in 1983 and 2008, were compared with each other including the variabilities such as size of the tumor, age of the patient and operation technique. Results: There were 100 patients in both of the groups. Six of the patients (6%), who were operated on in 1983, were found to be between the ages of 20-39 and this percentage was found to be much higher as 19% (19 patients) in 2008. In 1983, there wasn't any patient at stage 0 and the number of patients at stage 1 was 15 (15%), in 2008 the number of stage 0 patient was 9 (9%) and stage 1 patient was 25 (25%). Breast conserving surgery rate was found to be 9% in 1983 and 41% in 2008. Conclusions: According to the data of this study, breast cancer is now being seen at younger ages when compared to 25 years ago. Currently the patients have diagnosis at earlier stages and the breast conserving surgery is much more prevalent. Earlier-stage diagnosis can be explained by widespread use of screening mamographies and increasing consciousness of the patients.

Does breast cancer in Asian geriatric patients have the same biological characteristics as in their Western counterparts? A comparison between Shanghai and Vienna.

1550 Background: By 2030 it is estimated that 20% of the population will be 75 years of age or older. The incidence of breast cancer in Asia is especially rising, while the proportion of the population that is 60 and older is also growing. Today, approximately one-third of breast cancer occurs in women over the age of 65. The aim of this study was to investigate the biological differences of breast cancer older than 69 years in Asia and Europe. The results, including the stage at diagnosis and surgical therapy of Chinese breast cancer, were compared with their western counterparts. Methods: A total of 630 women, 70 years of age and older, with operable breast cancer were investigated in Shanghai and Vienna. Histopathological findings of 198 Austrian women seen during 2005 and 2010 were reviewed. The results were compared with 432 Chinese (time matched) obtained from the Breast Cancer Database in Shanghai. Results: The mean patients’ age in the Viennese and Shanghainese study groups were 75.3 and 77.9 years, respectively. In Austria, the breast-conserving surgery rate was 73.7% (n=146) compared to 10.4% (n=45) in China. Sentinel lymph node biopsy was performed in 40.4% (n=80) in Vienna vs. 8.3% (n=36) in Shanghai. More large tumors (tumor size > 2 cm) were detected in China (41.3%, n=169) than in Austria (34.7%, n=66) (p=0.033). No differences were found in axillary lymph node involvements (p=0.052). However, more grade-3 breast cancers were detected (p<0.001) in Austrians. Furthermore, there was a greater incidence of estrogen receptor-negative breast cancer in Chinese women (27%, n=113) compared to Austrian women (16.2%, n=32) (p<0.001). Conclusions: Chinese women present with a lower rate of grade-3 breast malignancies. As expected, a higher breast conserving surgery rate was noted in Vienna. Interestingly less Chinese women, although older than 69 years, were presented with estrogen receptor-positive breast cancer. We conclude that breast cancer characteristics are different in diverse ethnic groups. Ethnic-specific screening/therapy protocols may benefit this special Asian population, especially Asian women in western countries.

Prognosis and Prognostic Factors of the Micropapillary Pattern in Patients Treated for Stage II and III Serous Borderline Tumors of the Ovary

To determine the prognosis of a micropapillary (MP) pattern in patients with stage II and stage III serous borderline tumor of the ovary (SBOT). Review of patients with stage II and stage III SBOT treated or referred to our institution with characterization of an MP pattern and its clinical impact. In 1969-2006, 168 patients were reviewed. Fifty-six patients had SBOT-MP. The rate of conservative surgery was lower in the SBOT-MP group than in the typical SBOT group, but the rate of patients with more than three peritoneal sites with implants was higher in the SBOT-MP group. The rate of invasive implants was not statistically different between the two groups. Eighteen recurrences were observed (six of them in the form of invasive disease) in the SBOT-MP group. Only one death was observed. The overall survival times and recurrence-free intervals were similar in both groups. The only prognostic factor for recurrence in the SBOT-MP group was the use of conservative surgery. In the present series, an MP pattern doesn't appear to signify a poor prognosis. The only prognostic factor for recurrence in SBOT-MP was the use of conservative surgery. Further studies on the MP pattern are needed to evaluate prognosis and the results of conservative surgery.

Phase II Trial of Dose Dense Docetaxel Followed by FEC100 as Neoadjuvant Chemotherapy in Patients With Operable Breast Cancer

The aim of this study was to evaluate the efficacy and safety profile of 4 dose-dense cycles of docetaxel followed by 3 cycles of FEC100 neoadjuvant chemotherapy in patients with operable advanced breast cancer. Women were treated by 4 cycles of 100 mg/m² docetaxel every 2 weeks, followed by 3 cycles of FEC100 given every 3 weeks. The primary end point was pathologic complete response. Forty-five patients were treated. Ninety-three percent of the patients completed the planned 7 chemotherapy courses. The median relative dose intensity for docetaxel, 5-fluorouracil, epirubicin, and cyclophosphamide were 0.98, 0.97, 0.96, and 0.97, respectively. There were no therapy-related deaths. Two patients stopped chemotherapy because of cutaneous toxicity. During the docetaxel sequence, the most common grade 3-4 toxicities were (% pts): neutropenia (13.3), grade 3: cutaneous (24.4), myalgia and arthralgia (6.7). No clinical cardiac toxicity was observed. The pathologic complete response rate was 21.4% and 26.2% using Sataloff and Chevallier classifications, respectively. The conservative surgery rate was 62.2%. The median follow-up was 38.5 months. Two and 3-year disease-free survival rates were 79% and 64%, respectively. Two- and 3-year overall survival rate were 93% and 88%, respectively. This trial confirms the feasibility and efficacy of this dose dense docetaxel neoadjuvant regimen.

Taxane-based chemotherapy enhances response to neoadjuvant treatment for stage II and III breast cancer

Reducing primary tumor volume is the main role of neoadjuvant chemotherapy for breast cancer. We evaluated the benefit of adding docetaxel to anthracyclin as neoadjuvant therapy. This study is a retrospective cohort analysis comparing the efficacy of neoadjuvant chemotherapy in patients subjected to docetaxel and epirubicin or 5-fluoruracil, epirubicin and cyclophosphamide combinations (DE and FEC group, respectively). The mean number of chemotherapy delivered was similar in both groups (P = 0.8). A total of 316 patients were treated (151 in FEC group and 165 in DE group). Primary endpoint was the clinical and pathological response to therapy. Breast conserving surgery rate was compared. In T1/2 staged patients, the complete clinical response rate was 7.5% in FEC group and 32% in DE group (P = 0.002), and the breast conserving surgery rate was 72 and 73% in FEC and DE groups, respectively (P = 0.9). In the subset of patients staged as T3 and T4a-c, objective response was higher in DE group (P < 0.0001 and P = 0.008, respectively). Breast conserving surgery rate was 38 and 63% in FEC and DE groups, respectively, in T3 staged patients and, 20.5 and 37% in T4a-c staged patients (P = 0.003 and 0.08). Despite the similar number of chemotherapy cycles delivered in both groups, the presence of microscopic axillary lymph node involvement after chemotherapy was less frequent in DE group. Neoadjuvant chemotherapy with DE combination is more effective in terms of clinical and pathological response propitiating higher breast conserving surgery rate than FEC combination in stage II and III breast cancer.