CLINICS

Clinics (Sao Paulo). 2017 March; 72(3): 134-142.
doi:10.6061/clinics/2017(03)02

Copyright © 2017 CLINICS

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 I , Cristovam Scapulatempo-Neto II , Lucas Faria Abrahão-Machado II , Maria Mitzi Brentani III , João Soares Nunes IV , Maria Aparecida Azevedo Koike Folgueira III , René Aloisio da Costa Vieira I V *

Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Barretos/SP, Brazil

Hospital de Câncer de Barretos, Departamento de Patologia, Barretos/SP, Brazil

Faculdade de Medicina da Universidade de São Paulo, Disciplina de Oncologia, Departamento de Radiologia, São Paulo/SP, Brazil

Hospital de Câncer de Barretos, Departamento de Oncologica Clínica, Barretos/SP, Brazil

Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Departamento de Mastologia e Reconstrução Mamária, Barretos/SP, Brazil

*Corresponding author. E-mail: posgrad@hcancerbarretos.com.br

received August 20, 2016; revised October 9, 2016; accepted December 8, 2016.

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.

Keywords: Breast Neoplasms, Neoadjuvant Therapy, Drug Therapy Combination, Breast-Conserving Surgery, Recurrence, Disease-Free Survival


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