This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chen, A. M. Articles by Buchholz, T. A. Search for Related Content PubMed PubMed Citation Articles by Chen, A. M. Articles by Buchholz, T. A. Social Bookmarking                            What's this?

Breast Conservation After Neoadjuvant Chemotherapy: The M.D. Anderson Cancer Center Experience

From the Departments of Radiation Oncology, Surgical Oncology, Biomathematics, Breast Medical Oncology, and Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to Thomas A. Buchholz, MD, Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 97, Houston, TX 77030; e-mail: tbuchhol{at}mdanderson.org

PURPOSE: To determine patterns of local-regional recurrence (LRR) and ipsilateral breast tumor recurrence (IBTR) among patients treated with breast conservation therapy after neoadjuvant chemotherapy.

PATIENTS AND METHODS: Between 1987 and 2000, 340 cases of breast cancer were treated with neoadjuvant chemotherapy followed by conservative surgery and radiation therapy. Clinical stage at diagnosis (according to the 2003 American Joint Committee on Cancer system) was I in 4%, II in 58%, and III in 38% of patients. Only 4% had positive surgical margins.

RESULTS: At a median follow-up period of 60 months (range, 10 to 180 months), 29 patients had developed LRR, 16 of which were IBTRs. Five-year actuarial rates of IBTR-free and LRR-free survival were 95% and 91%, respectively. Variables that positively correlated with IBTR and LRR were clinical N2 or N3 disease, pathologic residual tumor larger than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The presence of any one of these factors was associated with 5-year actuarial IBTR-free and LRR-free survival rates of 87% to 91% and 77% to 84%, respectively. Initial T category (T1–2 v T3–4) correlated with LRR but did not correlate with IBTR (5-year IBTR-free rates of 96% v 92%, respectively, P = .19).

CONCLUSION: Breast conservation therapy after neoadjuvant chemotherapy results in acceptably low rates of LRR and IBTR in appropriately selected patients, even those with T3 or T4 disease. Advanced nodal involvement at diagnosis, residual tumor larger than 2 cm, multifocal residual disease, and lymphovascular space invasion predict higher rates of LRR and IBTR.

Supported by Department of Defense Breast Cancer Research Program Career Development Award BC980154 (T.A.B.).

Presented at the 2003 San Antonio Breast Cancer Symposium, San Antonio, TX, December 2003, where Dr Chen was recognized as an AstraZeneca distinguished scholar.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				H.-G. Moon, W. Han, J. W. Lee, E. Ko, E.-K. Kim, J.-H. Yu, S. Y. Kang, W. K. Moon, N. Cho, I.-A. Park, et al. Age and HER2 expression status affect MRI accuracy in predicting residual tumor extent after neo-adjuvant systemic treatment Ann. Onc., April 1, 2009; 20(4): 636 - 641. [Abstract] [Full Text] [PDF]

				S. Dawood, K. Broglio, S.-W. Kau, M. C. Green, S. H. Giordano, F. Meric-Bernstam, T. A. Buchholz, C. Albarracin, W. T. Yang, B. T.J. Hennessy, et al. Triple Receptor-Negative Breast Cancer: The Effect of Race on Response to Primary Systemic Treatment and Survival Outcomes J. Clin. Oncol., January 10, 2009; 27(2): 220 - 226. [Abstract] [Full Text] [PDF]

				T. A. Buchholz, C. D. Lehman, J. R. Harris, B. A. Pockaj, N. Khouri, N. F. Hylton, M. J. Miller, T. Whelan, L. J. Pierce, L. J. Esserman, et al. Statement of the Science Concerning Locoregional Treatments After Preoperative Chemotherapy for Breast Cancer: A National Cancer Institute Conference J. Clin. Oncol., February 10, 2008; 26(5): 791 - 797. [Abstract] [Full Text] [PDF]

				G. G. Steger, A. Galid, M. Gnant, B. Mlineritsch, A. Lang, C. Tausch, M. Rudas, R. Greil, C. Wenzel, C. F. Singer, et al. Pathologic Complete Response With Six Compared With Three Cycles of Neoadjuvant Epirubicin Plus Docetaxel and Granulocyte Colony-Stimulating Factor in Operable Breast Cancer: Results of ABCSG-14 J. Clin. Oncol., May 20, 2007; 25(15): 2012 - 2018. [Abstract] [Full Text] [PDF]

				M. Kaufmann, G. N. Hortobagyi, A. Goldhirsch, S. Scholl, A. Makris, P. Valagussa, J.-U. Blohmer, W. Eiermann, R. Jackesz, W. Jonat, et al. Recommendations From an International Expert Panel on the Use of Neoadjuvant (Primary) Systemic Treatment of Operable Breast Cancer: An Update J. Clin. Oncol., April 20, 2006; 24(12): 1940 - 1949. [Abstract] [Full Text] [PDF]

				V. Guarneri, K. Broglio, S.-W. Kau, M. Cristofanilli, A. U. Buzdar, V. Valero, T. Buchholz, F. Meric, L. Middleton, G. N. Hortobagyi, et al. Prognostic Value of Pathologic Complete Response After Primary Chemotherapy in Relation to Hormone Receptor Status and Other Factors J. Clin. Oncol., March 1, 2006; 24(7): 1037 - 1044. [Abstract] [Full Text] [PDF]

				A. Goldhirsch, J. H. Glick, R. D. Gelber, A. S. Coates, B. Thurlimann, H.-J. Senn, and and Panel Members Meeting Highlights: International Expert Consensus on the Primary Therapy of Early Breast Cancer 2005 Ann. Onc., October 1, 2005; 16(10): 1569 - 1583. [Abstract] [Full Text] [PDF]