Breast cancer patients with no surgery in the breast after an exceptional response to neoadjuvant chemotherapy: a case series.
Association of Breast Surgery ePoster Library. Teoh V. 05/13/19; 257132; P088
Dr. Victoria Teoh
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P088
Topic: Non surgical treatments
Introduction: Neoadjuvant chemotherapy (NACT) is increasingly used in phenotype-appropriate, early stage breast cancer with reported pathologic complete response (pCR) rates exceeding 60%. The utility of surgery after pCR is unknown, but is increasingly being questioned. We review the oncological outcomes of a small group of women, who declined surgery after NACT. Methods :Single-institution, retrospective case-series of breast cancer patients who declined surgery after NACT. They all achieved an excellent imaging response and had no residual disease (invasive or DCIS) on post-NACT, vacuum-assisted biopsy (VAB) of the breast. Sentinel lymph node biopsy/targeted axillary dissection was selectively performed.The primary outcome measure was locoregional recurrence on clinical and/or radiological assessment. Descriptive statistics were used. Results: Between 01/2015 to 06/2018, eight women declined surgery after NACT. The median age was 48 years (27-63) and median tumour size 52mm (12-80). Five were HER-2 positive and three were triple negative.All cases had pCR on breast VAB. Six (75%) had positive axillary nodes prior to NACT; 3 (50%) achieved axillary pCR, confirmed on SLNB/TAD. All received standard chemotherapy, with transtuzamab+pertuzumab if HER-2 positive. Seven women (87.5%) received radiotherapy to the breast, of whom two received additional regional nodal irradiation. Prescription dose was 50Gy in 25 fractions with boost.There were no locoregional recurrences at median follow up of 32.5 months (12-42).Conclusion:This case series must be interpreted with caution but is hypothesis-generating, signposting the need for research into the role and utility of surgery in exceptional NACT responders.
Topic: Non surgical treatments
Introduction: Neoadjuvant chemotherapy (NACT) is increasingly used in phenotype-appropriate, early stage breast cancer with reported pathologic complete response (pCR) rates exceeding 60%. The utility of surgery after pCR is unknown, but is increasingly being questioned. We review the oncological outcomes of a small group of women, who declined surgery after NACT. Methods :Single-institution, retrospective case-series of breast cancer patients who declined surgery after NACT. They all achieved an excellent imaging response and had no residual disease (invasive or DCIS) on post-NACT, vacuum-assisted biopsy (VAB) of the breast. Sentinel lymph node biopsy/targeted axillary dissection was selectively performed.The primary outcome measure was locoregional recurrence on clinical and/or radiological assessment. Descriptive statistics were used. Results: Between 01/2015 to 06/2018, eight women declined surgery after NACT. The median age was 48 years (27-63) and median tumour size 52mm (12-80). Five were HER-2 positive and three were triple negative.All cases had pCR on breast VAB. Six (75%) had positive axillary nodes prior to NACT; 3 (50%) achieved axillary pCR, confirmed on SLNB/TAD. All received standard chemotherapy, with transtuzamab+pertuzumab if HER-2 positive. Seven women (87.5%) received radiotherapy to the breast, of whom two received additional regional nodal irradiation. Prescription dose was 50Gy in 25 fractions with boost.There were no locoregional recurrences at median follow up of 32.5 months (12-42).Conclusion:This case series must be interpreted with caution but is hypothesis-generating, signposting the need for research into the role and utility of surgery in exceptional NACT responders.
P088
Topic: Non surgical treatments
Introduction: Neoadjuvant chemotherapy (NACT) is increasingly used in phenotype-appropriate, early stage breast cancer with reported pathologic complete response (pCR) rates exceeding 60%. The utility of surgery after pCR is unknown, but is increasingly being questioned. We review the oncological outcomes of a small group of women, who declined surgery after NACT. Methods :Single-institution, retrospective case-series of breast cancer patients who declined surgery after NACT. They all achieved an excellent imaging response and had no residual disease (invasive or DCIS) on post-NACT, vacuum-assisted biopsy (VAB) of the breast. Sentinel lymph node biopsy/targeted axillary dissection was selectively performed.The primary outcome measure was locoregional recurrence on clinical and/or radiological assessment. Descriptive statistics were used. Results: Between 01/2015 to 06/2018, eight women declined surgery after NACT. The median age was 48 years (27-63) and median tumour size 52mm (12-80). Five were HER-2 positive and three were triple negative.All cases had pCR on breast VAB. Six (75%) had positive axillary nodes prior to NACT; 3 (50%) achieved axillary pCR, confirmed on SLNB/TAD. All received standard chemotherapy, with transtuzamab+pertuzumab if HER-2 positive. Seven women (87.5%) received radiotherapy to the breast, of whom two received additional regional nodal irradiation. Prescription dose was 50Gy in 25 fractions with boost.There were no locoregional recurrences at median follow up of 32.5 months (12-42).Conclusion:This case series must be interpreted with caution but is hypothesis-generating, signposting the need for research into the role and utility of surgery in exceptional NACT responders.
Topic: Non surgical treatments
Introduction: Neoadjuvant chemotherapy (NACT) is increasingly used in phenotype-appropriate, early stage breast cancer with reported pathologic complete response (pCR) rates exceeding 60%. The utility of surgery after pCR is unknown, but is increasingly being questioned. We review the oncological outcomes of a small group of women, who declined surgery after NACT. Methods :Single-institution, retrospective case-series of breast cancer patients who declined surgery after NACT. They all achieved an excellent imaging response and had no residual disease (invasive or DCIS) on post-NACT, vacuum-assisted biopsy (VAB) of the breast. Sentinel lymph node biopsy/targeted axillary dissection was selectively performed.The primary outcome measure was locoregional recurrence on clinical and/or radiological assessment. Descriptive statistics were used. Results: Between 01/2015 to 06/2018, eight women declined surgery after NACT. The median age was 48 years (27-63) and median tumour size 52mm (12-80). Five were HER-2 positive and three were triple negative.All cases had pCR on breast VAB. Six (75%) had positive axillary nodes prior to NACT; 3 (50%) achieved axillary pCR, confirmed on SLNB/TAD. All received standard chemotherapy, with transtuzamab+pertuzumab if HER-2 positive. Seven women (87.5%) received radiotherapy to the breast, of whom two received additional regional nodal irradiation. Prescription dose was 50Gy in 25 fractions with boost.There were no locoregional recurrences at median follow up of 32.5 months (12-42).Conclusion:This case series must be interpreted with caution but is hypothesis-generating, signposting the need for research into the role and utility of surgery in exceptional NACT responders.
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