Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

Authors

  • Guilherme Freire Angotti Carrara Programa de Pós-Graduação em Oncologia; Hospital de Câncer de Barretos
  • Cristovam Scapulatempo-Neto Hospital de Câncer de Barretos; Departamento de Patologia
  • Lucas Faria Abrahão-Machado Hospital de Câncer de Barretos; Departamento de Patologia
  • Maria Mitzi Brentani Universidade de São Paulo; Disciplina de Oncologia; Departamento de Radiologia
  • João Soares Nunes Hospital de Câncer de Barretos; Departamento de Oncologica Clínica
  • Maria Aparecida Azevedo Koike Folgueira Universidade de São Paulo; Disciplina de Oncologia; Departamento de Radiologia
  • René Aloisio da Costa Vieira Hospital de Câncer de Barretos; Programa de Pós-Graduação em Oncologia; Departamento de Mastologia e Reconstrução Mamária

DOI:

https://doi.org/10.6061/clinics/2017(03)02

Keywords:

Breast Neoplasms, Neoadjuvant Therapy, Drug Therapy Combination, Breast-Conserving Surgery, Recurrence, Disease-Free Survival

Abstract

OBJECTIVE: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer. METHODS: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival. RESULTS: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01). CONCLUSIONS: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.

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Published

2017-03-01

Issue

Section

Clinical Sciences

How to Cite

Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up. (2017). Clinics, 72(3), 134-142. https://doi.org/10.6061/clinics/2017(03)02