Safety Of Breast-conserving Surgery Research Articles

Abstract P3-18-08: Feasibility and safety of breast-conserving surgery in early-stage breast cancers during the first trimester of pregnancy

Abstract Background: Breast cancer is the most common malignancy occurring during gestation and should be managed with the same protocols as for young non-pregnant women. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed radiation therapy (RT) is a reasonable alternative to radical mastectomy. Regrettably, no specific and widely adopted guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. Method: The first trimester was defined as 12 weeks and 6 days after the first day of the last menstruation. As for internal protocols, the surgical strategy for PrBC followed the same conservative-oriented schemes applied for nonpregnant patients. Only women with early-stage PrBC treated with BCS during pregnancy followed by planned RT to the whole breast after delivery were included. Exclusion criteria were i) clinical diagnosis or suspicion of inflammatory breast cancer; ii) multicentric disease; iii) diffuse malignant microcalcifications on mammography; iv) previous; v) connective tissue disease, and vi) syndromic breast cancers. All cases underwent central pathological review at the Pathology Department of the European Institute of Oncology. The primary outcome was the isolated local recurrence (ILR). Results: Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. None of the patients included in this study experienced perioperative surgical complications. No ILR was observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. The 5-year overall survival rate for all patients was 97% (n=29/30). Four patients experienced ILR or new carcinomas after 6-13 years. These patients are still alive and disease-free after 14-17 years of follow-up. Discussion: In our study, both adjuvant endocrine therapy and anti-HER2 treatment were postponed after delivery. Local recurrences/second primary tumors were observed in 4 out of 30 patients treated with BCS. Given that patient #4 did not receive postoperative RT, but an after-delivery mastectomy for preoperative diagnostic underestimation during pregnancy, this case does not represent a post-BCS recurrence. On the other hand, cases #1-3 could be considered real relapses. Two of these tumors occurred in patients that underwent CT during pregnancy, in which the interval between the end of systemic therapies and the onset of RT was not influenced by the pregnancy. In a single patient (not eligible for systemic treatment in pregnancy), the RT was performed with a longer interval than the usual one of the non-pregnant patients. Survival was not affected by local relapse, underlining the efficacy of salvage treatment.Conclusion: The findings of this study suggest that BCS in the first trimester of pregnancy can be considered reasonably safe for both mother and the child. Mammography should be mandatory in all patients for whom conservative surgery is recommended. Given that the availability of data concerning PrBC and its treatment is scarce and heterogeneous, multicentric studies are warranted. Citation Format: Nicola Fusco, Concetta Blundo, Massimo Giroda, Elham Sajjadi, Konstantinos Venetis, M. Cristina Leonardi, Elisa Vicini, Luca Despini, Claudia F. Rossi, Letterio Runza, Eugenia Di Loreto, Giovanna Scarfone, Elena Guerini-Rocco, Giuseppe Viale, Paolo Veronesi, Barbara Buonomo, Fedro A. Peccatori, Viviana E. Galimberti. Feasibility and safety of breast-conserving surgery in early-stage breast cancers during the first trimester of pregnancy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-08.

Long-term outcomes of women with large DCIS lesions treated with breast-conserving therapy.

The paucity of data on women with large (≥ 40mm) DCIS tumors lead to uncertainty on the safety of breast-conserving surgery (BCS) for these patients. We evaluated the impact of large tumor size on local recurrence (LR) among women with DCIS treated with BCS ± radiotherapy (RT). Treatment and outcomes were ascertained through administrative databases for all women with DCIS in Ontario from 1994 to 2003 treated with BCS ± RT with negative margins; 82% had pathology review. Cox proportional hazards model was used to evaluate the impact of tumor size on LR. 10- and 15-year LR-free survival (LRFS) were calculated using Kaplan-Meier method. The cohort includes 2049 women treated by BCS (N = 1073 with RT). Median follow-up is 14years (IQR 9-17years). Referenced to tumors ≤ 10mm, the risk of LR following BCS was significantly higher for larger tumors: HR ≥ 40mm = 3.67 (95% CI 2.13, 6.33; p < 0.001), HR 26-39mm = 2.27 (95% CI 1.47, 3.50, p < 0.001), and HR 11-25mm = 1.42 (95% CI 1.06, 1.92, p = 0.02). However, for individuals with BCS + RT, large tumor size was not associated with a significantly increased risk of LR (HR ≥ 40mm = 1.92 (95% CI 0.97, 3.79); HR 26-39mm = 1.81 (95% CI 1.09-2.99)). For women with tumors ≥ 40mm, 10-year LRFS risk for those treated by BCS alone, BCS + RT without boost, and BCS + RT with boost was 58.9%, 82.8%, and 83.9%. Large DCIS lesions ≥ 40mm are associated with higher risks of LR following BCS, but high long-term LRFS rates can be achieved with the addition of breast RT.

Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study.

Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.

Outcomes after breast-conserving surgery or mastectomy in patients with triple-negative breast cancer: meta-analysis.

In patients with triple-negative breast cancer (TNBC), oncological and survival outcomes based on locoregional treatment are poorly understood. In particular, the safety of breast-conserving surgery (BCS) for TNBC has been questioned. A meta-analysis was performed to evaluate locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) rates in patients with TNBC who had breast-conserving surgery versus mastectomy. Estimates were pooled in random-effects analysis. The effect of study-level co-variables was assessed by univariable metaregression. Fourteen studies, including 19 819 patients operated for TNBC met the inclusion criteria; 9828 patients (49.6 per cent) underwent BCS and 9991 (50.4 per cent) had a mastectomy. Patients with smaller tumours were more likely to be selected for BCS (pooled odds ratio (OR) for T1 tumours 1.95, 95 per cent c.i. 1.64 to 2.32; P < 0.001). The pooled OR for LRR was 0.64 (0.48 to 0.85; P = 0.002), indicating a statistically significantly lower odds of LRR among women who had BCS relative to mastectomy. The pooled OR for DM was 0.70 (0.53 to 0.94; P = 0.02), indicating a lower odds of DM among women who had BCS; however, this difference diminished with increasing study-level age and follow-up time. A pooled hazard ratio of 0.78 (0.69 to 0.89; P < 0.001) showed a significantly lower hazard for all-cause mortality among women undergoing BCS versus mastectomy. These results should be interpreted cautiously owing to likely differences in selection for BCS or mastectomy in the included studies. Patients with TNBC selected for BCS do not, however, have a worse prognosis than those treated with mastectomy, and breast conservation can be offered when feasible clinically.

Safety of Breast-Conserving Surgery in Breast Cancer and Risk of Overtreatment vs Undertreatment

Safety of Breast-Conserving Surgery in Breast Cancer and Risk of Overtreatment vs Undertreatment

Feasibility and safety of breast-conserving surgery via a periareolar incision for cancers located far from the nipple\u2013areolar complex: a retrospective study

PurposeWe performed breast-conserving surgery (BCS) using periareolar incisions for cancers located far from the nipple–areolar complex (NAC) and examined if BCS via a periareolar incision maximized cosmesis and maintained oncologic safety. One of the most important goals of BCS is to improve cosmesis after surgery and quality of life, but the skin incision can affect cosmesis based on the tumor location.MethodsFifty-five patients with breast cancers located far from the NAC underwent BCS via periareolar incisions between January 2017 and April 2018. If a sentinel lymph node biopsy was required, another skin incision was created in the axilla using the conventional technique. Medical records of patients were reviewed retrospectively.ResultsThe mean patient age was 48.1 ± 10.6 years. The mean tumor size was 1.8 ± 1.0 cm (range 0.2–4.5 cm) on preoperative magnetic resonance imaging (MRI); the mean distance from the NAC to the tumor was 5.9 ± 1.9 cm (range 4.0–12.3 cm). Patients with cancers in the subareolar area were excluded even though the distance from the nipple was > 4 cm on MRI. Negative microscopic margins were obtained in all patients. There was no surgical complication such as seroma, bleeding, or infection. Re-operation was not needed. All patients received whole breast radiation therapy. After surgery and radiation therapy, periareolar incision scars were nearly invisible.ConclusionFor cancers located far from the NAC, BCS via periareolar incisions is feasible and leads to superior cosmesis in selective patients. Moreover, BCS seems oncologically safe, although long-term outcomes need to be evaluated.

Abstract P4-13-07: Oncoplastic breast conservation surgery for patients with large breast cancers undergoing primary or post-NACT breast conservation surgery is safe and effective

Abstract Introduction: Majority of women diagnosed with breast cancers (BC) have self-detected large tumors (mean tumor size &amp;gt;4 cm). There are number of myths and misconceptions regarding safety of breast conservation surgery (BCS), which, coupled with the fear of re-operation for infiltrated margins lead to poor acceptance of BCS by Indian BC patients. Practice of oncoplastic breast surgery (OBS), neo-adjuvant chemotherapy (NACT) and intra-op frozen section (FS) margins assessment have helped us achieve safe, single stage breast conservation even for patients with large tumors. In this retrospective study, we evaluated the OBS techniques used in patients undergoing primary or post-NACT BCS and compared the outcomes in terms of ipsilateral breast tumor recurrence (IBTR) and overall survival (OS) between patient groups that underwent OBS-BCS, non-OBS BCS and mastectomy. Methods: Retrieving data from a prospectively maintained database, all patients treated for stages I-III BC between 2009 &amp; 2018 at a specialty breast surgery unit were reviewed. Patient demographics, TNM stage, pathology, OBS technique, margin re-excision, and outcomes in terms of IBTR and OS, were evaluated; and compared with non-OBS BCS and mastectomy patients. Results: Of 1884 (Median age 50 years, 59% post-menopausal, T3-18%, T4b-7%) who underwent curative breast surgery, 1424 (75%) underwent mastectomy. Rest 460 (24.4%) underwent BCS, of which 43% underwent OBS BCS. Fifty-two patients (26.6%) underwent post-NACT BCS, of which 27.5% had pathological complete response (pCR). OBS techniques used were volume displacement in 169 (86.4%) and volume replacement (mini LD/LD flap) in 29 (13.6%). The OBS techniques used constituted Level-1 OBS in 33% and level-2 OBS in 66%. Procedures performed included round block / modified Benelli-10.6%, batwing mastopexy- 6%, wise pattern reduction mammoplasty+contralateral symmetrization-4%, and other procedures-9.5% (medial mammoplasty, inverted T/vertical scar mastopexy, J or L mammoplasty, parallelogram excision, Z plasty). Intraop FS histology detected infiltrated margins in 11.6% of patients undergoing OBS-BCS, which were re-excised/ converted to mastectomy in the same sitting, thus avoiding a re-operation. In comparison, 17% patients who underwent non-OBS BCS had margin infiltration. Cosmetic outcomes and patient satisfaction were better in OBS BCS patients. Peri-op complications including partial nipple necrosis, skin necrosis, seroma, wound dehiscence and infection occurred in 17%. IBTR occurred in 4% of OBS-BCS patients, compared to 7% patients who underwent non-OBS BCS. Over 36 mo median follow-up, stagewise OS was similar in patient groups undergoing mastectomy, OBS BCS or non-OBS BCS. Conclusion: Employing OBS techniques has enabled us offer BCS for EBC and large or locally advanced BC. These techniques facilitate safe BCS of patients undergoing primary or post-NACT breast surgery, with relatively lower margin infiltration and local recurrence rates, comparable survival and higher patient satisfaction of their cosmetic outcomes, compared to patients undergoing mastectomy or conventional/ non-OBS BCS. Table: Types of oncoplastic procedures used in patients undergoing primary or post-NACT Oncoplastic breast surgical breast conservation surgeryNo.of patientsPercentageLevel I16181.3 %Level II(MiniLD/ LD/ Contralateral Symmetrisation)3718.6%Volume Displacement16985.3%Volume Replacement2913.6%Ipsilateral breast tumor recurrence84.02% Citation Format: Gaurav Agarwal, VC Ramya, Anjali Mishra, Gyan Chand, Sabaretnam Mayilvahanan, Vinita Agrawal, Narendra Krishnani, Namita Mohindra, Punita Lal. Oncoplastic breast conservation surgery for patients with large breast cancers undergoing primary or post-NACT breast conservation surgery is safe and effective [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-13-07.

The influence of molecular classification of breast cancer on the safety of breast-conserving surgery

Objective: To analyze the relationship between the breast cancer molecular classification and the prognosis of patients underwent breast-conserving therapy and to discuss the safety of the breast conserving surgery from the choice of operation in terms of breast cancer molecular classification. Methods: Clinical data of 618 patients with breast-conserving therapy in Tianjin Medical University Cancer Institute and Hospital from August 2005 to August 2010 were analyzed retrospectively. According to the molecular classification when breast cancer was diagnosed, patients were subdivided into five groups, including Luminal A, Luminal B1, Luminal B2, HER-2-positive and Triple-negative. Clinicopathological characteristics and prognosis were compared among five groups and the influencing factors of local recurrence, distant metastasis and overall survival were analyzed. Results: Among 618 patients, there were 148 cases Luminal A, 231 cases Luminal B1, 63 cases Luminal B2, 40 cases HER-2-positive and 136 cases Triple-negative. The age, family history, TNM stage, calcification, histological grade, pathological type and response to endocrine therapy of these 5 molecular types of breast cancer patients were significantly different (all P<0.05). The 5-year local regional recurrence-free survival rates of Luminal A, Luminal B1, Luminal B2, HER-2-positive and Triple-negative were 99.3%, 98.7%, 98.4%, 94.9% and 95.9%, respectively, without significant differences (P=0.104). The 5-year distant metastasis-free survival rates of these 5 types were 97.3%, 95.7%, 93.7%, 87.5% and 91.4%, respectively, with significant differences (P=0.013). Moreover, the 5-year overall survival rates of these 5 types were 98.6%, 97.8%, 98.4%, 92.5% and 95.6%, respectively, without significant differences (P=0.153). Multifactor analysis showed that radiotherapy (HR=0.036, P=0.049) and the number of lymph node metastases (HR=10.72, P=0.004) were independent factors of local recurrence of breast cancer patients underwent breast-conserving therapy. The age (HR=0.369, P=0.046), status of surgical margin (HR=5.486, P=0.007), number of lymph node metastases (HR=2.882, P=0.023) and molecular typing (HR=5.191, P=0.008) were independent factors of distant metastasis of above breast cancer patients. None of the factors were found to be independent factors of the overall survival of these breast cancer patients. Conclusions: Breast conserving therapy does not increase the risks of local recurrence and death of HER-2-positive and Triple-negative breast cancer patients. Therefore, breast conserving therapy can be accepted by patients with HER-2-positive and Triple-negative breast cancer.

86. Oncological safety of breast-conserving surgery after neo-adjuvant chemotherapy in locally advanced breast cancer patients

86. Oncological safety of breast-conserving surgery after neo-adjuvant chemotherapy in locally advanced breast cancer patients

Oncological Safety of Breast Conservation Surgery in Young Females.

Breast conservation surgery (BCS) is the standard of care in early breast cancer. The oncological safety of this procedure has been proven beyond doubt in several randomised control trials. But there are concerns regarding the safety of this procedure in young females. The concern is regarding increased risk of local recurrence. This issue has not been addressed in any major trial. In this prospective study we intend to look into the oncological safety of BCS in young patients who are less than forty years of age.

Abstract P1-14-19: Breast-Conserving Surgery after Neoadjuvant Chemotherapy is Oncologically Safe for Stage III Breast Cancer Patients

Abstract Background The use of breast-conserving surgery (BCS) in patients with large breast tumors downstaged by neoadjuvant chemotherapy (NCT) remains controversial in clinical stage III breast cancer patients because of the possibility of residual tumor and resistance to NCT. The aims of this study were 1) to evaluate the local recurrence (LR) rate depending on the use of NCT and 2) to determine the oncologic safety of BCS after NCT by comparing LR between patients treated with preplanned/downstaged BCS and patients treated with NCT and mastectomy in clinical stage III breast cancer patients. Patients and Methods Between 2000 and 2007, 166 patients with clinical stage III breast cancer received BCS or mastectomy after NCT (NCT group) and 193 patients with clinical stage III breast cancer who underwent surgery first (Surgery group). Among 166 patients of the NCT group, 94 patients (56.6%) received mastectomy after NCT (mastectomy after NCT group), 39 patients (23.5%) received preplanned BCS (preplanned BCS group) and 33 patients (19.9%) received downstaged BCS (downstaged BCS group). The LR rates between the groups were compared. Results At a median follow-up period of 66.9 months (range, 6.5 to 104.1 months), 11 patients in the NCT group and 7 patients in the Surgery group had developed LR. The 5-year LR-free survival rates were 93.6% in the NCT group and 95.9% in the Surgery group and the LR rates were not significantly different between the groups (p = 0.196). In the NCT group, LRs were observed in 6 patients in the mastectomy after NCT group, 3 patients in the preplanned BCS group and 2 patients in the downstaged BCS group. The 5-year LR-free survival rates were 94.4% in the mastectomy after NCT group, 92.0% in the preplanned BCS group and 93.9% in the downstaged BCS group, respectively (p = 0.953). Conclusions Our study demonstrated that the LR was not different depending on the use of NCT in the clinical stage III breast cancer patients. Also, clinical stage III breast cancer patients who received preplanned or downstaged BCS after NCT showed similar LR-free survival rates compared to patients who received mastectomy after NCT. This result supports that BCS after NCT in clinical stage III patients is oncologically safe in terms of LR if primary breast tumor size has became 5cm or less after NCT. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-19.

Preliminary Results: Double Lumpectomies for Multicentric Breast Carcinoma

The standard operation for patients with multicentric breast cancer is total mastectomy. The safety of breast-conserving surgery (BCS) for these patients is unknown but interest in BCS has recently resurfaced as a result of the detection of occult second malignancies by breast magnetic resonance imaging (MRI). We report a small number of patients who chose to undergo "double lumpectomies," defined as two separate segmental mastectomies for primary cancers in different quadrants of the same breast. Patients with multicentric breast cancer surgically managed with double lumpectomies at our institute were identified retrospectively. Clinicopathologic features are described and outcomes reported. Seven patients underwent double lumpectomies for multicentric carcinoma. Median age was 69 years (range, 61 to 80 years). In five patients, MRI identified ipsilateral second malignancies. All patients had two foci of invasive carcinoma, all tumors expressed estrogen receptor, and none showed HER-2 overexpression. Tumor sizes ranged from 0.7 to 2.9 cm. Six patients had histologically distinct tumors in the same breast: five had one invasive lobular carcinoma (ILC) and one invasive ductal carcinoma (IDC), and one had classic ILC in one quadrant and pleomorphic ILC in another. One patient had two foci of IDC in separate quadrants. All patients had sentinel lymph node biopsies and none had nodal metastasis. Median follow-up was 26 months (range, 18 to 85 months). No patient developed locoregional recurrence. This small series suggests that "double lumpectomy" may be considered for multicentric invasive breast carcinoma in carefully selected patients with favorable tumors who desire breast conservation.

Histopathological features of invasion of breast invasive ductal carcinoma and safety of breast-conserving surgery

In order to investigate the relationship between the extent of tumor invasion and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and histologic grading in breast invasive ductal carcinoma as well as the optimal extent of excision during the breast-serving surgery, the clinical data of 104 patients with breast invasive ductal carcinoma who had received modified radical mastectomy were analyzed. The correlation analysis on invasive extent, which was evaluated by serial sections at an interval of 0.5 cm from 4 different directions taking the focus as the centre, and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and histologic grading was processed. There was a significant correlation between invasive extent and tumor size (r=0.766, P<0.01), and lymph nodes metastases (r=0.574, P<0.01), but there was no significant correlation between invasive extent and Her-2 expression (r=0.106, P>0.05), and histologic grading (r=0.228, P>0.05). The 100% negative rate of infiltration in patients without nipple discharge with tumor size <2, 2-3 and >3 cm was obtained at 1.5, 2.0 and 2.5 cm away from the tumor respectively. It is concluded that the performance of breast-serving surgery in patients with breast invasive ductal carcinoma should be evaluated by tumor size in combination with axillary lymph nodes involvement to decide the possibility of breast-serving and the secure excision extent.

Feasibility Study of Safe Breast Conservation in Large and Locally Advanced Cancers with Use of Radiopaque Markers to Mark Pre‐Neoadjuvant Chemotherapy Tumor Margins

The lack of objective documentation of pre-neoadjuvant chemotherapy (NACT) margins after chemotherapy is a major constraint in performing safe breast-conserving surgery (BCS) in patients with locally advanced breast cancer (LABC). Using a novel method of marking pre-NACT tumor margins with indigenous silver wire markers, this prospective pilot study attempted to assess the feasibility of safe BCS in LABC patients by performing excision wide of the marked pre-NACT margins. LABC patients had sterile silver wire markers placed at all tumor margins percutaneously. Patients were then treated with NACT followed by wide local excision (WLE) incorporating pre-NACT margins (ex vivo on mastectomy specimen or in vivo in patients opting for BCS). The histology of the margins wide of the post-WLE cavity (pre-NACT) and post-NACT tumor was used to assess adequate disease clearance and safety of BCS. Altogether, 40 stage III breast cancer patients (mean tumor size 7.9 cm) were studied; none had marker-related complications. Following NACT, the tumor size assessed by markers showed average regression by 1.5 cm. The pre-NACT margins were histologically negative in 95% of the surgical specimens. In 2 (5%) patients both pre-NACT and post-NACT margins were positive; post-NACT margins were infiltrated in 14 (35%). The post-NACT WLE that is wide of the marked pre-NACT margins can achieve uninfiltrated margins in 95% of cases. If post-NACT margins are used to guide the WLE, 35% patients would have infiltrated margins, some of which would remain undetected, putting patients at high risk of local recurrence. This novel indigenous method of identifying tumor margins with sterile silver wire markers is safe, inexpensive, practical, and effective; and it may help perform safe BCS in a large proportion of LABC patients.

3–48 The Safety of Breast-Conserving Surgery in Patients Who Achieve a Complete Pathologic Response After Neoadjuvant Chemotherapy

3–48 The Safety of Breast-Conserving Surgery in Patients Who Achieve a Complete Pathologic Response After Neoadjuvant Chemotherapy

The safety of breast‐conserving surgery in patients who achieve a complete pathologic response after neoadjuvant chemotherapy

The objectives of this study were to determine the locoregional recurrence (LRR) rate and to evaluate the correlation between surgical resection volume (RV) and LRR in patients with breast cancer who underwent segmental mastectomy after achieving a pathologic complete response (pCR) on neoadjuvant chemotherapy. The authors reviewed the outcomes of all 109 patients who underwent segmental mastectomy after the complete eradication of invasive disease by neoadjuvant chemotherapy at their institution between 1987 and 2002. LRRs were recorded, and RVs after segmental mastectomy were calculated and categorized as small, medium, or large. At a median follow-up of 6.6 years, 3 patients (2.7%) developed LRR. In 2 of those patients, the recurrence was located in the ipsilateral breast; in the other patient, the recurrence was located in the supraclavicular lymph nodes with synchronous distant metastases. The median RV was 73.12 cm3 (range, 2.82-451.51 cm3). Large RVs (>125 cm3) were less common than small RVs (up to 70 cm3) or medium RVs (between 70 cm3 and 125 cm3; P = .009 and P<.0001, respectively). One patient with a small RV had an LRR at 4 years, and 2 patients with medium RVs had LLRs at 2.3 years and 6 years, respectively. The 5-year and 10-year LRR-free survival rates were 98.1% and 96.5%, respectively, and the corresponding overall survival rates were 96% and 92%, respectively. Segmental mastectomy was associated with excellent locoregional control in patients who achieved a pCR after neoadjuvant chemotherapy. Prospective studies are needed to examine whether decreasing the RVs in this patient population leads to an increased LRR rate.