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Review
. 2021 Dec 30;18(1):6-12.
doi: 10.4274/ejbh.galenos.2021.2021-5-4. eCollection 2022 Jan.

De-Escalation of Breast Cancer Surgery Following Neoadjuvant Systemic Therapy

Umar Wazir  1   2 , Kefah Mokbel  1
Affiliations
Review

De-Escalation of Breast Cancer Surgery Following Neoadjuvant Systemic Therapy

Umar Wazir et al. Eur J Breast Health. .

Abstract

Breast cancer treatment has seen many advances in recent decades, lessening the morbidity to patients, while improving outcomes. Central to these gains has been the introduction of breast conserving surgery and neoadjuvant systemic therapy (NST). There is a considerable interest in further de-escalation of the treatment of breast cancer, which is being studied in several ongoing randomised trials. We aimed to appraise the current literature regarding the various aspects of de-escalation of surgical treatment of breast cancer after NST, and attempt to prognosticate the future course of breast oncotherapy.

Keywords: Breast cancer; de-escalation; neo-adjuvant therapy.

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Conflict of interest statement

Conflict of Interest: K.M. has received honoraria for providing academic and clinical advisory to Merit Medical. U.W. declared no conflict of interest.

Figures

Figure 1
Figure 1
MRI demonstrating clinical complete response (cCR) of recurrent node positive TNBC in the right breast to NST that included Carboplatin and Pembroluzimab in a 50-year old woman (left: before NST; right: after NST. The patient achieved pCR. MRI: Magnetic resonance imaging, TNBC: Triple negative breast cancer, NST: Neoadjuvant systemic therapy
Figure 2
Figure 2
US scan of the right axilla demonstrating a pathological lymph node (cT0N1M0 TNBC) with an increased blood flow (left: before NST) that has responded well to NST (right: after NST). The Savi Scout reflector to facilitate targeted axillary dissection (TAD) is seen within the lymph node (right) US: Ultrasound, TNBC: Triple negative breast cancer, NST: Neoadjuvant systemic therapy
Figure 3
Figure 3
TAD guided by SAVI SCOUT TAD: Targeted axillary dissection
Figure 4
Figure 4
This 45-year-old lady presented with ER-HER2 + T3N1M0 breast cancer. She received 12 weeks of weekly paclitaxel and carboplatin and 3 weekly trastuzumab and pertuzumab followed by surgery that confirmed pCR. (a) MRI prior to treatment demonstrating the large primary tumour; (b) ultrasound scan of the axilla prior to treatment demonstrating the pathological lymph-node; (c) Ultrasound scan of the breast after NST showing non-specific textual change; (d) Ultrasound scan of the left axilla after NST showing a normal giraffe note containing the SAVI SCOUT reflector within it that was subsequently used to guide TAD HER2: Human epidermal growth factor receptor 2, MRI: Magnetic resonance imaging, NST: Neoadjuvant systemic therapy, TAD: Targeted axillary dissection
See this image and copyright information in PMC

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