Breast conservation after neoadjuvant chemotherapy

The M.D. Anderson cancer center experience

Allen M. Chen, Funda Meric-Bernstam, Kelly K. Hunt, Howard D. Thames, Mary Jane Oswald, Elesyia D. Outlaw, Eric A. Strom, Marsha D. McNeese, Henry M. Kuerer, Merrick I. Ross, S. Eva Singletary, Fredrick C. Ames, Barry W. Feig, Aysegul A. Sahin, George H. Perkins, Naomi R. Schechter, Gabriel N. Hortobagyi, Thomas A. Buchholz

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)2303-2312
Number of pages10
JournalJournal of Clinical Oncology
Volume22
Issue number12
DOIs
StatePublished - 2004
Externally publishedYes

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Breast
Recurrence
Drug Therapy
Neoplasms
Breast Neoplasms
Segmental Mastectomy
Residual Neoplasm
Radiotherapy
Survival Rate

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chen, A. M., Meric-Bernstam, F., Hunt, K. K., Thames, H. D., Oswald, M. J., Outlaw, E. D., ... Buchholz, T. A. (2004). Breast conservation after neoadjuvant chemotherapy: The M.D. Anderson cancer center experience. Journal of Clinical Oncology, 22(12), 2303-2312. https://doi.org/10.1200/JCO.2004.09.062

Breast conservation after neoadjuvant chemotherapy : The M.D. Anderson cancer center experience. / Chen, Allen M.; Meric-Bernstam, Funda; Hunt, Kelly K.; Thames, Howard D.; Oswald, Mary Jane; Outlaw, Elesyia D.; Strom, Eric A.; McNeese, Marsha D.; Kuerer, Henry M.; Ross, Merrick I.; Singletary, S. Eva; Ames, Fredrick C.; Feig, Barry W.; Sahin, Aysegul A.; Perkins, George H.; Schechter, Naomi R.; Hortobagyi, Gabriel N.; Buchholz, Thomas A.

In: Journal of Clinical Oncology, Vol. 22, No. 12, 2004, p. 2303-2312.

Research output: Contribution to journalArticle

Chen, AM, Meric-Bernstam, F, Hunt, KK, Thames, HD, Oswald, MJ, Outlaw, ED, Strom, EA, McNeese, MD, Kuerer, HM, Ross, MI, Singletary, SE, Ames, FC, Feig, BW, Sahin, AA, Perkins, GH, Schechter, NR, Hortobagyi, GN & Buchholz, TA 2004, 'Breast conservation after neoadjuvant chemotherapy: The M.D. Anderson cancer center experience', Journal of Clinical Oncology, vol. 22, no. 12, pp. 2303-2312. https://doi.org/10.1200/JCO.2004.09.062
Chen, Allen M. ; Meric-Bernstam, Funda ; Hunt, Kelly K. ; Thames, Howard D. ; Oswald, Mary Jane ; Outlaw, Elesyia D. ; Strom, Eric A. ; McNeese, Marsha D. ; Kuerer, Henry M. ; Ross, Merrick I. ; Singletary, S. Eva ; Ames, Fredrick C. ; Feig, Barry W. ; Sahin, Aysegul A. ; Perkins, George H. ; Schechter, Naomi R. ; Hortobagyi, Gabriel N. ; Buchholz, Thomas A. / Breast conservation after neoadjuvant chemotherapy : The M.D. Anderson cancer center experience. In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 12. pp. 2303-2312.
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title = "Breast conservation after neoadjuvant chemotherapy: The M.D. Anderson cancer center experience",
abstract = "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.",
author = "Chen, {Allen M.} and Funda Meric-Bernstam and Hunt, {Kelly K.} and Thames, {Howard D.} and Oswald, {Mary Jane} and Outlaw, {Elesyia D.} and Strom, {Eric A.} and McNeese, {Marsha D.} and Kuerer, {Henry M.} and Ross, {Merrick I.} and Singletary, {S. Eva} and Ames, {Fredrick C.} and Feig, {Barry W.} and Sahin, {Aysegul A.} and Perkins, {George H.} and Schechter, {Naomi R.} and Hortobagyi, {Gabriel N.} and Buchholz, {Thomas A.}",
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TY - JOUR

T1 - Breast conservation after neoadjuvant chemotherapy

T2 - The M.D. Anderson cancer center experience

AU - Chen, Allen M.

AU - Meric-Bernstam, Funda

AU - Hunt, Kelly K.

AU - Thames, Howard D.

AU - Oswald, Mary Jane

AU - Outlaw, Elesyia D.

AU - Strom, Eric A.

AU - McNeese, Marsha D.

AU - Kuerer, Henry M.

AU - Ross, Merrick I.

AU - Singletary, S. Eva

AU - Ames, Fredrick C.

AU - Feig, Barry W.

AU - Sahin, Aysegul A.

AU - Perkins, George H.

AU - Schechter, Naomi R.

AU - Hortobagyi, Gabriel N.

AU - Buchholz, Thomas A.

PY - 2004

Y1 - 2004

N2 - 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.

AB - 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.

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DO - 10.1200/JCO.2004.09.062

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EP - 2312

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

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