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

Guilherme Freire Angotti Carrara, Cristovam Scapulatempo-Neto, Lucas Faria Abrahão-Machado, Maria Mitzi Brentani, João Soares Nunes, Maria Aparecida Azevedo Koike Folgueira, René Aloisio da Costa Vieira

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    8 Scopus citations

    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.

    Original languageEnglish (US)
    Pages (from-to)134-142
    Number of pages9
    JournalClinics
    Volume72
    Issue number3
    DOIs
    StatePublished - Mar 2017

    Keywords

    • Breast neoplasms
    • Breast-conserving surgery
    • Disease-free survival
    • Drug therapy combination
    • Neoadjuvant therapy
    • Recurrence

    ASJC Scopus subject areas

    • Medicine(all)

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  • Cite this

    Carrara, G. F. A., Scapulatempo-Neto, C., Abrahão-Machado, L. F., Brentani, M. M., Nunes, J. S., Folgueira, M. A. A. K., & da Costa Vieira, R. A. (2017). 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. Clinics, 72(3), 134-142. https://doi.org/10.6061/clinics/2017(03)02