Regional Disease-free Survival Research Articles

Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience.

Simple SummaryIn patients with breast cancers larger than 2 cm undergoing neoadjuvant chemotherapy, there is a poor evaluation regarding the equivalence between oncoplastic surgery level II (OPSII) and mastectomy with immediate breast reconstruction (MIBR) regarding the aesthetic and oncological outcomes. The aim of our retrospective study was to assess whether OPSII is a safe alternative to MIBR. We confirmed the uniformity of the two techniques after neoadjuvant chemotherapy concerning loco-regional and systemic disease-free survival and overall survival in a population of 297 patients (87 undergoing OPSII, and 210 MIBR). In addition, we have highlighted how OPSII results in a lower loss of breast sensitivity after surgery and a better physical well-being of the chest. Therefore, in selected cases, OPSII should be preferred over MIBR, as it does not affect the oncological outcome, but improves physical well-being and allows the preservation of breast sensitivity in patients undergoing surgical treatment.Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC.

Sentinel Node Biopsy after Neoadjuvant Chemotherapy for Breast Cancer: Preliminary Experience with Clinically Node Negative Patients after Systemic Treatment.

Sentinel lymph node biopsy (SLNB) following neoadjuvant treatment (NACT) has been questioned by many studies that reported heterogeneous identification (IR) and false negative rates (FNR). As a result, some patients receive axillary lymph node dissection (ALND) regardless of response to NACT, leading to a potential overtreatment. To better assess reliability and clinical significance of SLNB status on ycN0 patients, we retrospectively analyzed oncological outcomes of 399 patients treated between January 2016 and December 2019 that were either cN0-ycN0 (219 patients) or cN1/2-ycN0 (180 patients). The Endpoints of our study were to assess, furthermore than IR: oncological outcomes as Overall Survival (OS); Distant Disease Free Survival (DDFS); and Regional Disease Free Survival (RDFS) according to SLNB status. SLN identification rate was 96.8% (98.2% in patients cN0-ycN0 and 95.2% in patients cN+-ycN0). A median number of three lymph nodes were identified and removed. Among cN0-ycN0 patients, 149 (68%) were confirmed ypN0(sn), whereas regarding cN1/2-ycN0 cases 86 (47.8%) confirmed an effective downstaging to ypN0. Three year OS, DDFS and RDFS were significantly related to SLNB positivity. Our data seemed to confirm SLNB feasibility following NACT in ycN0 patients, furthermore reinforcing its predictive role in a short observation timing.

IGF-1R expression in localized cervical carcinoma patients treated by radiochemotherapy

Purpose To assess the expression of IGF-1R in cervix carcinoma patients treated by radiotherapy and concomitant chemotherapy, its relation to clinical and pathologic prognostic factors and its role in predicting clinical outcome. Materials and methods Sixty consecutive patients suffering from localized cervix carcinoma were prospectively included in this study from July 1999 to December 2003. Follow-up was closed in March 2006. Patients were staged following the TNM classification. All patients were referred to pelvic radiation up to doses of 45–64.80 Gy in 1.8–2 Gy fractions followed brachytherapy treatment. External radiotherapy boost was used in one patient not receiving brachytherapy (total dose up to 64.80 Gy). All patients received concomitant cisplatin at 40 mg/m 2/week doses during pelvic radiation. IGF-1R expression was studied by immunohistochemistry in paraffin-embedded tumor tissue. Results IGF-1R was expressed in 56 patients (93.7%) and no relation was found with clinicopathological variables. Complete response after treatment was observed in 50 patients (83.3%). Clinical stage of the disease and clinical response to radiotherapy were the most important prognostic factors related to survival. Low (negative and fairly) IGF-1R tumor expression was correlated to better long-term Local and Regional Disease Free Survival ( p = 0.045), Disease-Free Survival ( p = 0.045), Cause-Specific Survival ( p = 0.032) and Overall Survival ( p = 0.021) in patients achieving a complete response. Conclusion High IGF-1R expression is related with reduced long-term local control due to tumor disease radiochemoresistance in patients who initially respond to definitive radiotherapy and concomitant chemotherapy.