Surgical Features after Neoadjuvant Treatment for Breast Cancer (original) (raw)
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International Surgery Journal
Background: Locally advanced diseased of the breast is characterised clinically by features suggesting infiltration of the skin or chest wall by tumour or matted involved axillary nodes (AJCC-stage III). Successful reduction in the size of the tumor is associated with increased rate of operability i.e., modified radical mastectomy or breast conserving therapy (BCT). The aim of this study is to assess outcome of surgery in management of locally advanced breast carcinoma (LABC) after neoadjuvant chemotherapy.Methods: It is an observational retrospective study of 40 cases of LABC admitted at general surgery department.Results: The response to neoadjuvant chemotherapy was seen in 92.5% cases- with complete response in 10% cases (4 patients) and partial response in 82.5% (33 patients). No response was observed in 7.5% cases (3 patients) after 4 cycles of neoadjuvant chemotherapy. All patients were subjected to surgery after chemotherapy, out of whom 02 patients (5%) have surgical site in...
International Surgery Journal, 2020
Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy...
Evaluation and Reporting of Breast Cancer after Neoadjuvant Chemotherapy
The Open Pathology Journal
Neoadjuvant chemotherapy (NAC) applied prior to surgical excision of the tumor has become a frequently used therapeutic approach in patients with operable and inoperable breast cancer. Such chemotherapy alters the morphology of breast cancers and normal breast tissue. Thus it is important for pathologists to become familiar with these changes and to know how to handle and assess breast specimens after neoadjuvant chemotherapy. Evaluation of the therapeutic response and measurement of residual disease is important in the pathologic assessment of the final surgical resection specimens because these data help in predicting patient's chances for cure and survival, and also provide guidance for further therapy. This review will discuss treatment effects and demonstrate how to evaluate, sample and measure residual breast cancer in excision specimens including axillary lymph nodes.
Factors influencing the time to surgery after neoadjuvant chemotherapy in breast cancer patients
Archives of Gynecology and Obstetrics, 2020
Purpose It is suspected that delayed surgery after neoadjuvant chemotherapy (NACT) leads to a worse outcome in breast cancer patients. We therefore evaluated possible influencing factors of the time interval between the end of NACT and surgery. Methods All patients receiving NACT due to newly diagnosed breast cancer from 2015 to 2017 at the Department of Gynecology, Saarland University Medical Center, were included. The time interval between end of NACT and surgery was defined as primary endpoint. Possible delaying factors were investigated: age, study participation, outpatient and inpatient presentations, implants/expander, MRI preoperatively, discontinuation of chemotherapy, and genetic mutations. Results Data of 139 patients was analyzed. Median age was 53 years (22–78). The time interval between end of NACT and surgery was 28 days (9–57). Additional clinical presentations on outpatient basis added 2 days (p = 0.002) and on inpatient basis added 7 days to time to surgery (p < ...
Impact of Progression During Neoadjuvant Chemotherapy on Surgical Management of Breast Cancer
Annals of Surgical Oncology, 2010
Background. Although neoadjuvant chemotherapy (NCT) is standard therapy for locally advanced breast cancer, it remains controversial for early-stage disease due to concerns that disease progression may make breast-conservation therapy (BCT), or even operability, impossible. The goal of this study was to determine the impact of disease progression during NCT on surgical management. Methods. We reviewed clinicopathological data on patients who received NCT for stage I-III breast cancer from 1994 to 2007. Chemotherapy regimens were anthracycline-and/or taxane-based as determined by the treating medical oncologist. Results. Of 1,928 patients who received NCT, 1,762 (91%) had a partial or complete response, 107 (6%) had stable disease (SD), and 59 (3%) progressed (PD) while receiving at least one regimen. Of the patients with progressive disease, 40 (68%) patients underwent mastectomy, 12 (20%) underwent BCT, and 7 (12%) did not undergo surgery. In patients who underwent mastectomy, only three (8%) were BCT candidates before progression. Overall, disease progression changed the operative plan in 11 (0.5%) patients: 3 developed distant metastasis, 2 developed clinical lymphadenopathy, 3 required mastectomy instead of BCT, 2 became inoperable, and 1 required flap closure. Conclusions. Disease progression while receiving NCT is infrequent (3%), but early identification may allow for change to other, potentially beneficial, therapeutic
Indian Journal of Surgical Oncology, 2017
Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. This is a prospective feasibility cohort study of oncoplastic breast surgery after neoadjuvant chemotherapy that was carried at the National Cancer Institute, Cairo University and included 70 patients. The primary outcome was the local recurrence rate. Secondary outcomes included survival and margins obtained as well as cosmetic outcomes. Survival analysis was performed. Oncoplastic breast surgery did not compromise oncologic safety in the patients included in the study. It even allowed wider margins of resection which could be associated with better oncologic outcomes. At the same time, it gave a better cosmetic outcome and therefore higher patient satisfaction. Oncoplastic breast surgery includes a wide spectrum of surgical techniques, ranging from the basic level I techniques in breast conserving surgery to the more complex procedures of level II which are broadly classified into volume replacement (therapeutic mammoplasty) and volume displacement procedures. We suggest that oncoplastic breast surgery techniques should be the standard of care in breast surgery. They are the basis for breast conserving surgery techniques in early breast cancer. In our experience, oncoplastic surgery is feasible in locally advanced tumours after downstaging with neoadjuvant chemotherapy without compromising the oncologic safety.
“No Ink on Tumor” in Breast-Conserving Surgery after Neoadjuvant Chemotherapy
Journal of Personalized Medicine
Background/Aim: Patients with Stage I-II breast cancer undergoing breast-conserving surgery after neoadjuvant chemotherapy (BCS-NAC) were retrospectively assessed in order to evaluate the extent of a safe excision margin. Materials and Methods: Between 2003 and 2020, 151 patients underwent risk-adapted BCS-NAC; margin involvement was always assessed at definitive histology. Patients with complete pathological response (pCR) were classified as the RX group, whereas those with residual disease and negative margins were stratified as R0 < 1 mm (margin < 1 mm) and R0 > 1 mm (margin > 1 mm). Results: Totals of 29 (19.2%), 64 (42.4%), and 58 patients (38.4%) were included in the R0 < 1 mm, R0 > 1 mm, and RX groups, respectively, and 2 patients with margin involvement had a mastectomy. Ten instances of local recurrence (6.6%) occurred, with no statistically significant difference in local recurrence-free survival (LRFS) between the three groups. A statistically significan...
Annals of Surgical Oncology, 2015
Background. The current retrospective study was intended to obtain up-to-date and comprehensive data on surgical practice for breast cancer throughout France, including neoadjuvant chemotherapy (NAC) and the more recent surgical techniques of oncoplastic surgery (OPS). Methods. In June 2011, e-mail surveys were sent to 33 nationally renowned breast cancer surgeons from French public or private hospitals. The questionnaire focused on all the new cases of breast cancer treated in 2010. It included questions regarding surgical practices, with special emphases on NAC and OPS and other surgical characteristics.
Clinical breast cancer, 2015
The aim of this study was to assess the rate of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (nCT) in patients for whom mastectomy (MT) was, initially, the only conceivable surgical option. Between 2007 and 2012, 168 patients from a single center received nCT. Among these patients, we focused on the ones who received nCT (n = 119, [70.8%]) to decrease tumor size and thus to potentially allow a conservative surgical treatment. For these patients, MT was initially the only possible surgical treatment. Among the 119 patients included, 118 presented with an invasive ductal carcinoma. The mean tumor size before nCT, measured using magnetic resonance imaging, was 41.6 mm (range, 15-110 mm) and 25.3 mm (range, 0-90 mm) after nCT. Eighty-six patients (72.3%) underwent BCS, and oncoplastic techniques were used in 29 patients (33.6%). Only 4.3% (5 patients) of patients who were treated with BCS needed additional surgery because of positive surgical margins. The median follow...