Factors influencing the time to surgery after neoadjuvant chemotherapy in breast cancer patients (original) (raw)
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Annals of surgical oncology, 2015
No studies have examined the impact of the interval from conclusion of neoadjuvant chemotherapy to surgery in breast cancer patients. This study was undertaken to investigate the relationship between time interval from neoadjuvant chemotherapy to surgery and survival outcomes. Breast cancer patients diagnosed with stage I-III disease who received neoadjuvant chemotherapy June 1995 to April 2007 were identified. The effect of neoadjuvant chemotherapy to surgery interval, defined as ≤4, 4-6, or >6 weeks, on survival outcomes was examined. Descriptive statistics and Cox proportional hazards models were used. A total of 1101 patients were identified. Median time to surgery was 33 (range 8-159) days; 335 patients (30.4 %) had surgery within 4 weeks of their last dose of neoadjuvant chemotherapy, 524 (47.6 %) within 4-6 weeks, and 242 (22.0 %) after more than 6 weeks. Median follow-up was 94 (range 3-178) months. The 5-year overall survival (OS) estimates were 79, 87, and 81 % in patie...
The American Journal of Surgery, 2020
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Surgical Features after Neoadjuvant Treatment for Breast Cancer
2021
Introduction: Patients with breast cancer may receive neoadjuvant cancer treatment in order to benefit from radical surgery or to turn an indication for extensive surgery into a conservatory or oncoplastic operation. AIM To establish the main implications of therapeutic management of the cases of breast cancer treated initially with chemotherapy followed by surgery. MATERIAL AND METHOD 35 breast cancer patients operated in 2020 after NACT (neoadjuvant chemotherapy) in Surgery Clinic of Coltea Hospital are analyzed, and the response after treatment is pathologicaly evaluated using the Residual Cancer Burden method Results: The results of the analysis of the group of patients showed that most patients presented downstaging of the disease after neoadjuvant treatment with a proportion of 17,14% with complete pathologic response. DISCUSSIONS We performed clinical and imagistic evaluation of patients before and after NACT and pathologic evaluation of the surgical specimen using residual t...
Transactions of The ... Meeting of The American Surgical Association, 2006
To determine the effect of preoperative chemotherapy on the volume of tissue excised and the number of breast operations in patients undergoing breast-conserving therapy (BCT). Summary Background Data: Preoperative chemotherapy is increasingly being used for breast cancer and increases rates of BCT. Its impact on the extent of surgery and the number of surgical procedures in BCT has never been fully defined. The extent of surgery in BCT directly affects cosmesis. Methods: We reviewed the records of 509 consecutive patients with T1-T3, N0 -N2 breast cancer who were treated in prospective randomized clinical trials of chemotherapy between 1998 and 2005. We analyzed the final surgical procedure (BCT or mastectomy), the number of operations, and, in patients who underwent BCT, re-excision rates, and the total volume of breast tissue excised ͓4⌸/3(width/2 ϫ length/2 ϫ height/2)͔. Results: A total of 241 patients underwent BCT, and 268 patients underwent mastectomy. Among BCT patients who had initial tumor size Ͼ2.0 cm, patients who received preoperative chemotherapy had significantly smaller volumes of breast tissue excised compared with patients who received postoperative chemotherapy (113 cm 3 vs. 213 cm 3 , P ϭ 0.004). The re-excision rate and total number of breast operations did not significantly differ between the groups. Among BCT patients who had initial tumor size Յ2 cm, preoperative chemotherapy had no impact on volume of breast tissue excised, re-excision rate, or number of breast operations (P Ͼ 0.05). Conclusions: Among patients treated with BCT for larger breast tumors, patients treated with preoperative chemotherapy have less extensive resection, with no change in rates of re-excision. (Ann Surg 2006;244: 464 -470)
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
Treatment delay in breast cancer; does it really have an impact on prognosis?
2002
Data is limited on treatment delay and its prognostic impact on breast cancer patients. In this study, we retrospectively measured the time between biopsy and surgery and between surgery to adjuvant therapy in our patients, and analyzed the prognostic impact of this delay. Ninety-six regularly followed patients with breast cancer, treated with mastectomy and adjuvant chemotherapy±radiotherapy were analyzed for the effect of time intervals between biopsy to surgery and surgery to adjuvant chemotherapy on relapse free survival (RFS). Standard prognostic factors (age, tumor size, grade, axilla and hormone receptor status) were also evaluated. In the univariate analysis, age, tumor diameter, number of axillary nodes involved, estrogen receptor status and time to surgery (quick surgery worse) showed a statistical significance. In the multivariate analysis, older age, smaller tumor and smaller number of axillary nodes involved were associated with a better relapse free survival (RFS) (P&l...
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...
American Journal of Clinical Oncology, 2014
Objectives: To analyze factors that influence the timing of adjuvant chemotherapy in patients who are candidates for breast-conservation therapy (BCT) but elect mastectomy with immediate reconstruction (M-IR). Methods: We identified 35 consecutively treated patients with stage I or II breast cancer between 2004 and 2009 who underwent M-IR and adjuvant chemotherapy from the University of Louisville Cancer Registry. We matched these patients for age and AJCC stage to 35 controls who underwent BCT and adjuvant chemotherapy. We examined the timing and delay of initiation of chemotherapy using univariate logistic regression and McNemar test for matched pairs. Results: For the 70 patients evaluated, the median age was 46 years (range, 30 to 65 y), and the distribution for stage I, IIA, and IIB was 22.9%, 65.7%, and 11.4%, respectively. The 2 groups were well balanced in terms of race, rural/urban status, smoking, diabetes, insurance coverage, and histology. For BCT and M-IR, the median time to chemotherapy initiation was 38 days (range, 25 to 103 d) and 55 days (range, 30 to 165 d), respectively. Patients undergoing M-IR were more likely to experience any delay (> 45 d; 54.3% vs. 22.9%; P < 0.001) and/or significant delay (> 90 d; 20.0% vs. 2.9%; P < 0.001). On univariate logistic regression analysis, surgery type had a major impact on delay of chemotherapy (odds ratio = 8.35; 95% confidence interval, 2.86-24.4; P < 0.001). Conclusions: The use of M-IR in breast-conservation candidates independently predicts for delay in initiation of adjuvant chemotherapy. Further study is needed to qualify the causes and clinical significance of these delays.