Breast-Conserving Surgery after Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer: Single Institute Experience

Esmat, Mohamed; El-Sheshtawy, Wael

doi:10.21608/ejhm.2019.26599

Breast-Conserving Surgery after Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer: Single Institute Experience

Document Type : Original Article

Authors

Mohamed Esmat ¹
Wael El-Sheshtawy ²

¹ Department of General Surgery (Surgery Oncology Unit), Faculty of Medicine, Al-Azhar University, Cairo, Egypt

² Department of Clinical Oncology Faculty of Medicine, Al-Azhar University, Cairo, Egypt

10.21608/ejhm.2019.26599

Abstract

Background: from clinical and pathologic aspects, locally advanced breast cancer (LABC) can be considered a relatively heterogeneous group of tumors. Objective: we aimed to evaluate local control after breast-conserving surgery in patients with locally advanced breast cancer who received neoadjuvant chemotherapy for down staging. Patients and Methods: a retrospective study was performed to include patients with locally advanced breast cancer who underwent breast-conserving surgery after neoadjuvant chemotherapy (anthracylcine based regimen followed by taxans). The clinical, pathologic, and surgical factors that could contribute to locoregional recurrence were evaluated. Results: after neoadjuvant chemotherapy, 94 patients underwent breast-conserving surgery. The average tumor diameter was 5.3 cm, and 87.8% of patients achieved a size of up to 3 cm. Furthermore, 85.7% were at clinical stage III, 75.5% had T3-T4 tumors, 81.6% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic optimal response was achieved in 26.5% of the tumors, and all the samples had free margins. The 5- year overall survival rate was 81.6%, and the mean follow-up duration was 94.1 months. The rate of ipsilateral breast tumor recurrence was 10.2%, while the rate of locoregional recurrence was 16.3%. The regression analysis showed that multifocal morphology response was the only factor associated with ipsilateral breast tumor recurrence (p=0.04). The pathologic response evaluation criteria in solid tumors (RECIST) breast cutoff was the only factor associated with locoregional recurrence (p=0.01). Conclusion: breast-conserving surgery is a safe and effective therapeutic option for selected locally advanced breast tumors after receiving neoadjuvant chemotherapy.

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