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. 2021 Jan;123(1):71-79.
doi: 10.1002/jso.26236. Epub 2020 Oct 1.

Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de-escalate surgical treatments

Antonio Esgueva  1 , Christian Siso  2 , Martin Espinosa-Bravo  2 , Carolina Sobrido  3 , Ignacio Miranda  4 , Juan P Salazar  4 , Isabel T Rubio  1
Affiliations

Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de-escalate surgical treatments

Antonio Esgueva et al. J Surg Oncol. 2021 Jan.

Abstract

Introduction: Breast conservative surgery (BCS) and sentinel lymph node biopsy (SLNB) after neoadjuvant treatment (NAT) is safe and effective for selected patients. This aim of this study is to evaluate the impact of anatomic site of response on outcomes and to assess the real population who may benefit from nonsurgical approaches after NAT.

Material and methods: From a prospectively maintained database, patients with T1-4 N0-2 breast cancer undergoing NAT were identified. Clinicopathological and survival rates were compared in relation to response and anatomic site of response.

Results: Six hundred and forty-six patients were included in the study. Pathologic complete response (pCR) was an independent factor for BCS and SLN. HER2 positive and TN tumors with cN0 achieving a breast pCR remain ypN0 (p = .002). Residual axillary disease was associated with breast residual tumor (p = .05) and subtype (p = .001). With a median follow up of 35.25 months, patients with any pCR had improved survival when compared with partial response, but not significant differences between pCR, axillary pCR, or breast pCR.

Conclusion: Achieving a pCR increases BCS and SLN. In selected subgroups, sparing any axillary surgery after NAT maybe feasible. In cN+ patients, any pCR was associated with survival, but not the anatomic site of response.

Keywords: breast neoplasms; de-escalation; neoadjuvant therapy; pathologic complete response; survival.

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References

REFERENCES

    1. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol. 2004;22:2303-2312.
    1. Golshan M, Loibl S, Wong SM, et al. Breast conservation after neoadjuvant chemotherapy for triple-negative breast cancer: surgical results from the brightness randomized clinical trial. JAMA Surg. 2020;155:e195410.
    1. Early Breast Cancer Tialists' Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomized trials. Lancet Oncol. 2018;19:27-39.
    1. Rubio IT, Wyld L, Cardoso F, et al. Perspectives on preoperative systemic treatment and breast conservative surgery: one step forward or two steps back? Breast. 2018;41:133-135.
    1. Boughey JC, Peintinger F, Meric-Bernstam F, et al. Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg. 2006;244:464-470.

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