Response to primary systemic treatment and its influence on the extent of subsequent axillary surgery - single center experience
Association of Breast Surgery ePoster Library. Daskalova I. 05/15/17; 166198; P116
Ms. Iskra Daskalova
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Abstract
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Introduction: Primary systemic treatment (PST) in selected breast cancer (BC) patients has become more common in the last decade. We evaluated the influence of PST on the extent of subsequent axillary surgery.
Methods: Between September 2014 and November 2016 34 BC patients (stage II-III) underwent PST followed by surgery in our institution. One was treated with primary hormonotherapy (5 months), the other 33 received chemotherapy. Nineteen patients were biopsy-confirmed node positive before PST - 13 of them luminal type, 2 triple positive, 1 Her2 type, and 3 triple negative.
Results: Of 19 N(+) patients initially considered for axillary clearance (AC), 13 underwent SNB after PST due to axillary image downstaging. Five of these 13 had positive SNB on frozen section and underwent AC. Seven of these 13 after negative frozen section on final histology had either isolated tumor cells (ITC) only (4 patients) or macrometastasis in a single SLN (3 patients) with at least 1 more negative SLN. None of these 7 patients chose to have further AC, but they all underwent axillary radiotherapy. One patient had axillary pCR based on SNB. In total 5 patients (26%) were ypN0sn (including 1 pCR and 4 ITC+) and avoided AC. Three out of 13 (23%) primary N(+)patients with luminal type and 2 out of 3 triple negative (67%) avoided AC.
Conclusion: After PST of primary N(+) patients less extensive axillary surgery could be sufficient in approximately 25% of patients. A higher axillary response is found in triple negative patients.
Methods: Between September 2014 and November 2016 34 BC patients (stage II-III) underwent PST followed by surgery in our institution. One was treated with primary hormonotherapy (5 months), the other 33 received chemotherapy. Nineteen patients were biopsy-confirmed node positive before PST - 13 of them luminal type, 2 triple positive, 1 Her2 type, and 3 triple negative.
Results: Of 19 N(+) patients initially considered for axillary clearance (AC), 13 underwent SNB after PST due to axillary image downstaging. Five of these 13 had positive SNB on frozen section and underwent AC. Seven of these 13 after negative frozen section on final histology had either isolated tumor cells (ITC) only (4 patients) or macrometastasis in a single SLN (3 patients) with at least 1 more negative SLN. None of these 7 patients chose to have further AC, but they all underwent axillary radiotherapy. One patient had axillary pCR based on SNB. In total 5 patients (26%) were ypN0sn (including 1 pCR and 4 ITC+) and avoided AC. Three out of 13 (23%) primary N(+)patients with luminal type and 2 out of 3 triple negative (67%) avoided AC.
Conclusion: After PST of primary N(+) patients less extensive axillary surgery could be sufficient in approximately 25% of patients. A higher axillary response is found in triple negative patients.
Introduction: Primary systemic treatment (PST) in selected breast cancer (BC) patients has become more common in the last decade. We evaluated the influence of PST on the extent of subsequent axillary surgery.
Methods: Between September 2014 and November 2016 34 BC patients (stage II-III) underwent PST followed by surgery in our institution. One was treated with primary hormonotherapy (5 months), the other 33 received chemotherapy. Nineteen patients were biopsy-confirmed node positive before PST - 13 of them luminal type, 2 triple positive, 1 Her2 type, and 3 triple negative.
Results: Of 19 N(+) patients initially considered for axillary clearance (AC), 13 underwent SNB after PST due to axillary image downstaging. Five of these 13 had positive SNB on frozen section and underwent AC. Seven of these 13 after negative frozen section on final histology had either isolated tumor cells (ITC) only (4 patients) or macrometastasis in a single SLN (3 patients) with at least 1 more negative SLN. None of these 7 patients chose to have further AC, but they all underwent axillary radiotherapy. One patient had axillary pCR based on SNB. In total 5 patients (26%) were ypN0sn (including 1 pCR and 4 ITC+) and avoided AC. Three out of 13 (23%) primary N(+)patients with luminal type and 2 out of 3 triple negative (67%) avoided AC.
Conclusion: After PST of primary N(+) patients less extensive axillary surgery could be sufficient in approximately 25% of patients. A higher axillary response is found in triple negative patients.
Methods: Between September 2014 and November 2016 34 BC patients (stage II-III) underwent PST followed by surgery in our institution. One was treated with primary hormonotherapy (5 months), the other 33 received chemotherapy. Nineteen patients were biopsy-confirmed node positive before PST - 13 of them luminal type, 2 triple positive, 1 Her2 type, and 3 triple negative.
Results: Of 19 N(+) patients initially considered for axillary clearance (AC), 13 underwent SNB after PST due to axillary image downstaging. Five of these 13 had positive SNB on frozen section and underwent AC. Seven of these 13 after negative frozen section on final histology had either isolated tumor cells (ITC) only (4 patients) or macrometastasis in a single SLN (3 patients) with at least 1 more negative SLN. None of these 7 patients chose to have further AC, but they all underwent axillary radiotherapy. One patient had axillary pCR based on SNB. In total 5 patients (26%) were ypN0sn (including 1 pCR and 4 ITC+) and avoided AC. Three out of 13 (23%) primary N(+)patients with luminal type and 2 out of 3 triple negative (67%) avoided AC.
Conclusion: After PST of primary N(+) patients less extensive axillary surgery could be sufficient in approximately 25% of patients. A higher axillary response is found in triple negative patients.
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