Impact of neoadjuvant chemotherapy in the surgical treatment of breast cancer
Keywords:
breast cancer, neoadjuvant chemotherapy, prognosis, surgery, mastectomy, quadrantectomyAbstract
Introduction: Neoadjuvant chemotherapy is an increasingly frequent option in the treatment of breast cancer. One of the goals of neoadjuvant chemotherapy is to change the indication for a mastectomy to a conservative surgery, and for axillary lymphadenectomy to sentinel lymph node assessment. Methods: This was an observational, cross-sectional, retrospective study that evaluated response to neoadjuvant chemotherapy in breast cancer patients undergoing surgical treatment. Patients were divided into three groups when the surgery indication was changed after neoadjuvant chemotherapy: downgrade, unchanged, upgrade. Results: During the study period, 355 patients were included with a mean age of 55 years. Neoadjuvant chemotherapy promoted a downgrade in 38.7% of patients with indication for mastectomy and an upgrade in 36.8% of patients with indication for conservative surgery; in the total group, the maintenance of indication for surgery was 62,2%. In the axillary approach, lymphadenectomy downgrade was 6.9% and sentinel lymph node biopsy upgrade was 34% with 27% being due to positivity and 7% due to disease progression. Multivariate analysis found a significant difference between clinical staging and change in surgical indication for both breast and axilla (p<0.0001). In the multivariate analysis of pathologic complete response and change of indication for breast and axilla surgery, triple negative and HER-2-positive tumors showed a significant difference (p<0.0001). Conclusions: Neoadjuvant chemotherapy was able to perform a downgrade of breast and axilla surgery in few patients and there was no relationship between the change of indication and pathologic complete response
Downloads
References
Nickson C, Velentzis LS, Brennan P, Mann GB, Houssami N. Improving breast cancer screening in Australia: a public health perspective. Public Health Res Pract. 2019;29(2):e2921911. https://doi.org/10.17061/phrp2921911
Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019;394(10204):1159-68. https://doi.org/10.1016/S0140-6736(19)31709-X
Moisin A, Manda G, Bratu DG, Serban D, Smarandache CG, Motofei C, et al. Efficiency of modified radical mastectomy in the therapeutic conduct of breast cancer. Rom Biotechnol Lett. 2021;26(1):2331-9. https://doi.org/10.25083/rbl/26.1/2331.2339
French DP, Southworth J, Howell A, Harvie M, Stavrinos P, Watterson D, et al. Psychological impact of providing women with personalised 10-year breast cancer risk estimates. Br J Cancer. 2018;118(12):1648-57. https://doi.org/10.1038/s41416-018-0069-y
Schünemann HJ, Lerda D, Quinn C, Follmann M, Alonso-Coello P, Rossi PG, et al. Breast cancer screening and diagnosis: a synopsis of the European Breast Guidelines. Ann Int Med. 2020;172(1):46-56. https://doi.org/10.7326/M19-2125
Asaoka M, Gandhi S, Ishikawa T, Takabe K. Neoadjuvant chemotherapy for breast cancer: past, present, and future. Breast Cancer (Auckl). 2020;14:1178223420980377. https://doi.org/10.1177/1178223420980377
Wang H, Mao X. Evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer. Drug Des Devel Ther. 2020;14:2423-33. https://doi.org/10.2147/DDDT.S253961
Rastogi P, Anderson SJ, Bear HD, Gever CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26(5):778-85. https://doi.org/10.1200/JCO.2007.15.0235
Berruti A, Generali D, Kaufmann M, Puztai L, Curigliano G, Aglietta M, et al. International expert consensus on primary systemic therapy in the management of early breast cancer: highlights of the fourth symposium on primary systemic therapy in the management of operable breast cancer, Cremona, Italy (2010). J Natl Cancer Inst Monogr. 2011;2011(43):147-51. https://doi.org/10.1093/jncimonographs/lgr037
Komenaka IK, Hibbard ML, Hsu CH, Low BG, Salganick JA, Bouton ME, et al. Preoperative chemotherapy for operable breast cancer improves surgical outcomes in the community hospital setting. Oncologist. 2011;16(6):752-9. https://doi.org/10.1634/theoncologist.2010-0268
Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, Khan AS, et al. Neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer: ASCO guideline. J Clin Oncol. 2021;39(13):1485-505. https://doi.org/10.1200/JCO.20.03399
Poggio F, Bruzzone M, Ceppi M, Pondé NF, La Valle G, Del Mastro L, et al. Platinum-based neoadjuvant chemotherapy in triple-negative breast cancer: a systematic review and meta-analysis. Ann Oncol. 2018;29(7):1497-508. https://doi.org/10.1093/annonc/mdy127
Gnat M, Harbeck N, Thomssen C. St. Gallen/Vienna 2017: A Brief Summary of the Consensus Discussion about Escalation and De-Escalation of Primary Breast Cancer Treatment. Breast Care (Basel). 2017;12(2):102-7. https://doi.org/10.1159/000475698
Byrski T, Gronwald J, Huzarski T, Dent RA, Zuziak D, Wiśniowski R, et al. Neoadjuvant therapy with cisplatin in BRCA1-positive breast cancer patients. Hered Cancer Clin Pract. 2011;9(Suppl 2):A4. https://doi.org/10.1186/1897-4287-9-S2-A4
Jasra S, Anampa J. Anthracycline use for early stage breast cancer in the modern era: a review. Curr Treat Options Oncol. 2018;19(6):30. https://doi.org/10.1007/s11864-018-0547-8
Caparica R, Bruzzone M, Poggio F, Ceppi M, Azambuja E, Lambertini M. Anthracycline and taxane-based chemotherapy versus docetaxel and cyclophosphamide in the adjuvant treatment of HER2-negative breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Breast Cancer Res Treat. 2019;174(1):27-37. https://doi.org/10.1007/s10549-018-5055-9
Kreutzfeldt J, Rozeboom B, Dey N, De P. The trastuzumab era: current and upcoming targeted HER2+ breast cancer therapies. Am J Cancer Res. 2020;10(4):1045-67. PMID: 32368385.
Spring LM, Fell G, Arfe A, Sharma C, Greenup R, Reynolds KL, et al. Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: a comprehensive meta-analysis. Clin Cancer Res. 2020;26(12):2838-48. https://doi.org/10.1158/1078-0432.CCR-19-3492
Trabert B, Sherman ME, Kannan N, Stanczyk FZ. Progesterone and breast cancer. Endoc Rev. 2020;41(2):320-44. https://doi.org/10.1210/endrev/bnz001
Ward MC, Vicini F, Chadha M, Pierce L, Recht A, Hayman J, et al. Radiation therapy without hormone therapy for women age 70 or above with low-risk early breast cancer: a microsimulation. Int J Radiat Oncol Biol Phys. 2019;105(2):296-306. https://doi.org/10.1016/j.ijrobp.2019.06.014
von Minckwitz G, Blohmer JU, Costa S, Denkert C, Eidtmann H, Eirmann W, et al. Neoadjuvant chemotherapy adapted by interim response improves overall survival of primary breast cancer patients – results of the GeparTrio trial. Cancer Res. 2011;71(24 Supplement):S3-2. https://doi.org/10.1158/0008-5472.SABCS11-S3-2
Antunovic L, De Sanctis R, Cozzi L, Kirienko M, Sagona A, Torrise R, et al. PET/CT radiomics in breast cancer: promising tool for prediction of pathological response to neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging. 2019;46(7):1468-77. https://doi.org/10.1007/s00259-019-04313-8
Costa MADL, Chagas SRP. Quimioterapia neoadjuvante no câncer de mama operável: revisão da literatura. Rev Bras Cancerol. 2013;59(2):261-9.
Petruolo O, Sevilimedu V, Montagna G, Le T, Morrow M, Barrio AV. How often does modern neoadjuvant chemotherapy downstage patients to breast-conserving surgery? Ann Surg Oncol. 2021;28(1):287-94. https://doi.org/10.1245/s10434-020-08593-5
Cao L, Sugumar K, Keller E, Li P, Rock L, Simpson A, et al. Neoadjuvant endocrine therapy as an alternative to neoadjuvant chemotherapy among hormone receptor-positive breast cancer patients: pathologic and surgical outcomes. Ann Surg Oncol. 2021;28(10):5730-41. https://doi.org/10.1245/s10434-021-10459-3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Marcelo Antonini, André Mattar, Gabriel Duque Pannain, Odair Ferraro, Reginaldo Guedes Coelho Lopes, Luiz Henrique Gebrim, Juliana Monte Real
This work is licensed under a Creative Commons Attribution 4.0 International License.
