Breast Conservation after Neoadjuvant Chemotherapy

Epidemiology

General

Risk Factors

Presentation and Evaluation

Anatomy

Pathology

Clinical Presentation

Routes of Spread

Diagnostic Studies

Staging

Treatment

Outcome

Prognostic Factors

Summary

Studies

NSABP B-18 (Wolmark JNCI 01, Fisher JCO 97)
Eligibility
Treatment

  • Chemotherapy: four cycles of doxorubicin (60 mg/m2)/cyclophosphamide(600 mg/m2) (AC) chemotherapy every 21 days
  • Surgery: lumpectomy and axillary lymph node dissection or modified radical mastectomy
  • Radiation: Given for patients with lumpectomies
  • Pre-op regiment: ACx4/TAM x 5 year - Surgery - RT (if lumpectomy)
  • Post-op regiment: Surgery - AC x 4 - RT(if lumpectomy) - TAM x 5 years

Results

Groups 9-OS 9-DFS IBRT Lumpectomy
pre-op 69% 55% 10.7% 59.8%
post-op 70% 53% 7.6% 67.8%
p-value N.S. N.S. N.S.

Conclusions

  • 12% more lumpectomies in preoperative group
  • > 20% of patients who were initially considered unresectable become resectable after chemotehrapy
  • Ipsilateral breast tumor recurrence was higher in pre-operative group 10.7% 7.6%, but not statistically significant.
Bibliography
1. Cox J, Ang K. Radiation Oncology: rationale Technique Results. 8th ed. New York: Mosby, 2003.
2. Gunderson L, Tepper J: Clinical Radiation Oncology. 2nd ed. China: Elsevier 2007.
3. Devita V, Hellman S, Rsenberg S: Cancer: Principles and practice of Oncology. 7th ed. Philadelphia: Lippincott, 2005.
4. Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997 Jul;15(7):2483-93.
PMID: 9215816
5. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;(30):96-102. PMID: 11773300
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