Nodal response to neoadjuvant chemotherapy - time to think of outside the box!
Association of Breast Surgery ePoster Library. Pakzad F. 05/15/17; 166348; P027
Farrokh Pakzad
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Abstract
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Introduction
In node positive operable breast cancer, debate remains as to whether complete pathological response (cPR) to neoadjuvant chemotherapy (NACT) can be used to surgically spare a down staged axilla.
This retrospective study compares the response rates to NACT in bot the index primary tumour and the axillary nodes. .
Methods
A retrospective analysis of patient who underwent NACT between 2009-2014 was carried out. Patient demographics, tumour characteristics, locoregional nodal status, surgical parameters and final pathology was analysed.
Node positive patients underwent axillary dissection. Surgical management of the index primary tumour was dictated by the response to NACT and followed standard management paradigms.
Results
219 patients (mean age 46 years, all female) were included.
Overall, cPR was seen at the primary and/or the nodal basin(s) in 44% (88/219).
112 (51%) presented with biopsy proven node positive disease. Overall, cPR rate in the axilla was 57% (64/112) and 40% (45/112) in the primary breast site. Breakdown of response rates showed cPR in primary tumour only in 4% (5/112), both the breast and the axilla in 36% (40/122) and the axilla only in 21% (24/112). cPR was highest in the triple negative and Her-2 positive tumours (p<0.01) .
Conclusion
Biological response to NACT in the axilla does occur but does not always correlate with the response seen in the breast. While the findings support the argument for sparing the axilla, strategies for assessment and management of axillary nodes post-NACT should be carried out independent to the response seen in the breast.
In node positive operable breast cancer, debate remains as to whether complete pathological response (cPR) to neoadjuvant chemotherapy (NACT) can be used to surgically spare a down staged axilla.
This retrospective study compares the response rates to NACT in bot the index primary tumour and the axillary nodes. .
Methods
A retrospective analysis of patient who underwent NACT between 2009-2014 was carried out. Patient demographics, tumour characteristics, locoregional nodal status, surgical parameters and final pathology was analysed.
Node positive patients underwent axillary dissection. Surgical management of the index primary tumour was dictated by the response to NACT and followed standard management paradigms.
Results
219 patients (mean age 46 years, all female) were included.
Overall, cPR was seen at the primary and/or the nodal basin(s) in 44% (88/219).
112 (51%) presented with biopsy proven node positive disease. Overall, cPR rate in the axilla was 57% (64/112) and 40% (45/112) in the primary breast site. Breakdown of response rates showed cPR in primary tumour only in 4% (5/112), both the breast and the axilla in 36% (40/122) and the axilla only in 21% (24/112). cPR was highest in the triple negative and Her-2 positive tumours (p<0.01) .
Conclusion
Biological response to NACT in the axilla does occur but does not always correlate with the response seen in the breast. While the findings support the argument for sparing the axilla, strategies for assessment and management of axillary nodes post-NACT should be carried out independent to the response seen in the breast.
Introduction
In node positive operable breast cancer, debate remains as to whether complete pathological response (cPR) to neoadjuvant chemotherapy (NACT) can be used to surgically spare a down staged axilla.
This retrospective study compares the response rates to NACT in bot the index primary tumour and the axillary nodes. .
Methods
A retrospective analysis of patient who underwent NACT between 2009-2014 was carried out. Patient demographics, tumour characteristics, locoregional nodal status, surgical parameters and final pathology was analysed.
Node positive patients underwent axillary dissection. Surgical management of the index primary tumour was dictated by the response to NACT and followed standard management paradigms.
Results
219 patients (mean age 46 years, all female) were included.
Overall, cPR was seen at the primary and/or the nodal basin(s) in 44% (88/219).
112 (51%) presented with biopsy proven node positive disease. Overall, cPR rate in the axilla was 57% (64/112) and 40% (45/112) in the primary breast site. Breakdown of response rates showed cPR in primary tumour only in 4% (5/112), both the breast and the axilla in 36% (40/122) and the axilla only in 21% (24/112). cPR was highest in the triple negative and Her-2 positive tumours (p<0.01) .
Conclusion
Biological response to NACT in the axilla does occur but does not always correlate with the response seen in the breast. While the findings support the argument for sparing the axilla, strategies for assessment and management of axillary nodes post-NACT should be carried out independent to the response seen in the breast.
In node positive operable breast cancer, debate remains as to whether complete pathological response (cPR) to neoadjuvant chemotherapy (NACT) can be used to surgically spare a down staged axilla.
This retrospective study compares the response rates to NACT in bot the index primary tumour and the axillary nodes. .
Methods
A retrospective analysis of patient who underwent NACT between 2009-2014 was carried out. Patient demographics, tumour characteristics, locoregional nodal status, surgical parameters and final pathology was analysed.
Node positive patients underwent axillary dissection. Surgical management of the index primary tumour was dictated by the response to NACT and followed standard management paradigms.
Results
219 patients (mean age 46 years, all female) were included.
Overall, cPR was seen at the primary and/or the nodal basin(s) in 44% (88/219).
112 (51%) presented with biopsy proven node positive disease. Overall, cPR rate in the axilla was 57% (64/112) and 40% (45/112) in the primary breast site. Breakdown of response rates showed cPR in primary tumour only in 4% (5/112), both the breast and the axilla in 36% (40/122) and the axilla only in 21% (24/112). cPR was highest in the triple negative and Her-2 positive tumours (p<0.01) .
Conclusion
Biological response to NACT in the axilla does occur but does not always correlate with the response seen in the breast. While the findings support the argument for sparing the axilla, strategies for assessment and management of axillary nodes post-NACT should be carried out independent to the response seen in the breast.
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