Assessing the Impact of Neoadjuvant Chemotherapy on the Management of the Breast and Axilla in Breast Cancer |
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| Affiliation: | 1. Athens University Medical School, 8 Iassiou Street, 11521, Athens, Greece;2. Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands;3. Institut Français du Sein, 15 rue Jean Nicot, 75007, Paris, France;4. Istanbul Faculty of Medicine, Istanbul University, Bahçelievler Mahallesi, E-5 Yanyol, Kültür Sokak, No: 14, Metroport Busidence, Bahçelievler, İstanbul, 34180, Istanbul, Turkey;5. Surgical Breast Unit, Catholic University of Rome, Largo Agostino Gemelli, 8, 00168, Rome, Italy;1. Division of Medical Senology, European Institute of Oncology, Milan, Italy;2. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy;3. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy;4. Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Italy;5. Integrated Breast Surgery Unit, European Institute of Oncology and University of Milan, Italy;6. Division of Senology, European Institute of Oncology, Milan, Italy;7. Division of Radiation Oncology, European Institute of Oncology, Milan, Italy;8. Department of Medicine, European Institute of Oncology, Milan, Italy;1. UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy;2. UOC di Anatomia Patologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy;3. UOC di Chirurgia Senologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy;4. Radius s.r.l, Budrio, Italy;5. Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy;6. Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy;1. Department of Neurosurgery, Brigham and Women’s Hospital, 15 Francis Street-PBB3, Boston, MA 02115, USA;2. Department of Neurosurgery, Northwestern University, Chicago, IL, USA;3. Department of Hematology/Oncology, Northwestern University, Chicago, IL, USA;1. Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT;2. Department of Medical Oncology, Yale School of Medicine, New Haven, CT;3. Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, CT;4. Department of Surgery, Yale School of Medicine, New Haven, CT;5. Department of Pathology, Yale School of Medicine, New Haven, CT;6. Department of Medicine, Yale School of Medicine, New Haven, CT |
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| Abstract: | BackgroundNodal status is a sensitive prognostic indicator in breast cancer. Axillary metastases may be an indication for neoadjuvant systemic therapy. The aims of this study were to compare pathologic response rates to neoadjuvant chemotherapy (NAC) in the breast and axilla across different molecular subtypes of breast cancer and to compare the predictive value of axillary assessment before and after chemotherapy in determining final nodal status in this cohort of patients.Patients and MethodsThe cohort comprised patients undergoing NAC from 2003 to November 2012. Data regarding patient and tumor characteristics, management, and outcomes were obtained from a prospectively maintained database and analyzed using PASW Statistics, version 18 (SPSS Inc, Chicago, IL).ResultsTwo hundred two cancers were identified in 196 patients. One hundred thirty-one (65%) diagnostic axillary procedures were performed, 105 (80%) before NAC, of which 93 (89%) were positive. In 28 (30%), downstaging was noted before NAC. Human epidermal growth factor receptor 2 (HER2) subtypes had the highest rate of complete pathologic response (n = 11 [61%]) and negative axillary clearance (AXCn) (n = 11 [69%]). Of 177 AXCns, 68 (38%) were negative before NAC.ConclusionAXCn in patients undergoing NAC remains controversial. HER2 subtypes are less likely to have axillary involvement after NAC and may demand different management. |
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| Keywords: | Axilla Breast cancer HER2 Neoadjuvant chemotherapy Pathologic response |
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