Top

Published in:

01-03-2009 | Breast Oncology

Preoperative Chemotherapy Decreases the Need for Re-Excision of Breast Cancers Between 2 and 4 cm Diameter

Authors: Carla J. Christy, MD, David Thorsteinsson, MD, Baiba J. Grube, MD, MS, Dalliah Black, MD, Maysa Abu-Khalaf, MD, Gina G. Chung, MD, Michael P. DiGiovanna, MD, PhD, Kenneth Miller, MD, Susan A. Higgins, MD, Joanne Weidhaas, MD, PhD, Lyndsay Harris, MD, Fattaneh A. Tavassoli, MD, Donald R. Lannin, MD

Published in: Annals of Surgical Oncology | Issue 3/2009

Abstract

Introduction

It is accepted that preoperative chemotherapy can result in increased breast preservation for breast cancers greater than 4 cm. The benefits of preoperative chemotherapy are less clear, however, for patients who present with smaller tumors and are already candidates for breast-preserving surgery. The goal of this study is to assess the effect of preoperative chemotherapy on breast cancers between 2 and 4 cm diameter.

Methods

A retrospective chart review was conducted of patients diagnosed with new breast cancer at the Yale-New Haven Breast Center for the years 2002–2007. Patients were included in the study if their breast cancer was between 2 and 4 cm and their initial surgical treatment had been completed. Patients with distant metastases were excluded.

Results

There were 156 new cancers that met study requirements. Forty-seven patients underwent preoperative chemotherapy, and 109 patients had their surgery first, usually followed by chemotherapy. Initial surgery was lumpectomy for 31 out of 47 patients (66%) in the preoperative chemotherapy group compared with 62 out of 109 patients (57%) in the surgery group. For patients with lumpectomies, 2 out of 31 patients (6%) in the preoperative group had positive margins and required re-excision compared with 20 out of 62 patients (37%) in the surgery-first group (P < 0.01).

Conclusions

We conclude that, for tumors between 2 and 4 cm, preoperative chemotherapy is associated with a significantly decreased rate of re-excision following lumpectomy. This not only results in fewer mastectomies, but also avoids the morbidity and inferior cosmetic results associated with a re-excision lumpectomy.

Bonadonna G, Veronesi U, Brambilla C, et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst. 1990;82(19):1539–45.PubMedCrossRef

Khanna MM, Mark RJ, Silverstein MJ, et al. Breast conservation management of breast tumors 4 cm or larger. Arch Surg. 1992;127(9):1038–41; discussion 1041–3.PubMed

Harris JR. Diseases of the breast. Philadelphia: Lippincott; 1995.

Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997;15(7):2483–93.PubMed

Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16(8):2672–85.PubMed

Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;30:96–102.PubMed

Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol. 2004;22(12):2303–12.PubMedCrossRef

Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy. Cancer. 2005;103(4):689–95.PubMedCrossRef

Lannin DR, Grube B, Black DS, Ponn T. Breast tattoos for planning surgery following neoadjuvant chemotherapy. Am J Surg. 2007;194(4):518–20.PubMedCrossRef

10.

Grube BJ, Christy CJ, Black D, et al. Breast sentinel lymph node dissection before preoperative chemotherapy. Arch Surg. 2008;143(7):692–9; discussion 699–700.PubMedCrossRef

11.

Cochrane RA, Valasiadou P, Wilson AR, et al. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90(12):1505–9.PubMedCrossRef

12.

Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10(3):356–63.PubMed

13.

Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA. The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol. 1999;25(6):566–70.PubMedCrossRef

14.

Mullenix PS, Cuadrado DG, Steele SR, et al. Secondary operations are frequently required to complete the surgical phase of therapy in the era of breast conservation and sentinel lymph node biopsy. Am J Surg. 2004;187(5):643–6.PubMedCrossRef

15.

Anscher MS, Jones P, Prosnitz LR, et al. Local failure and margin status in early-stage breast carcinoma treated with conservation surgery and radiation therapy. Ann Surg. 1993;218(1):22–8.PubMedCrossRef

16.

Swanson GP, Rynearson K, Symmonds R. Significance of margins of excision on breast cancer recurrence. Am J Clin Oncol. 2002;25(5):438–41.PubMedCrossRef

17.

Tartter PI, Bleiweiss IJ, Levchenko S. Factors associated with clear biopsy margins and clear reexcision margins in breast cancer specimens from candidates for breast conservation. J Am Coll Surg. 1997;185(3):268–73.PubMed

18.

Smitt MC, Nowels KW, Zdeblick MJ, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer. 1995;76(2):259–67.PubMedCrossRef

19.

Mirza NQ, Vlastos G, Meric F, et al. Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy. Ann Surg Oncol. 2002;9(3):256–65.PubMedCrossRef

20.

Sadetzki S, Oberman B, Zipple D, et al. Breast conservation after neoadjuvant chemotherapy. Ann Surg Oncol. 2005;12(6):480–7.PubMedCrossRef

21.

Loibl S, von Minckwitz G, Raab G, et al. Surgical procedures after neoadjuvant chemotherapy in operable breast cancer: results of the GEPARDUO trial. Ann Surg Oncol. 2006;13(11):1434–42.PubMedCrossRef

22.

Newman LA, Buzdar AU, Singletary SE, et al. A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility. Ann Surg Oncol. 2002;9(3):228–34.PubMedCrossRef

23.

Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188–94.PubMedCrossRef

24.

Kurtz JM. Factors influencing the risk of local recurrence in the breast. Eur J Cancer. 1992;28(2–3):660–6.PubMedCrossRef

25.

Macmillan RD, Purushotham AD, George WD. Local recurrence after breast-conserving surgery for breast cancer. Br J Surg. 1996;83(2):149–55.PubMedCrossRef

26.

England DW, Chan SY, Stonelake PS, Lee MJ. Assessment of excision margins following wide local excision for breast carcinoma using specimen scrape cytology and tumour bed biopsy. Eur J Surg Oncol. 1994;20(4):425–9.PubMed

27.

Rubin P, O’Hanlon D, Browell D, et al. Tumour bed biopsy detects the presence of multifocal disease in patients undergoing breast conservation therapy for primary breast carcinoma. Eur J Surg Oncol. 1996;22(1):23–6.PubMedCrossRef

28.

Taylor I, Mullee MA, Carpenter R, et al. The significance of involved tumour bed biopsy following wide local excision of breast cancer. Eur J Surg Oncol. 1998;24(2):110–3.PubMedCrossRef

29.

Malik HZ, Purushotham AD, Mallon EA, George WD. Influence of tumour bed assessment on local recurrence following breast-conserving surgery for breast cancer. Eur J Surg Oncol. 1999;25(3):265–8.PubMedCrossRef

30.

Jenkinson AD, Al-Mufti RA, Mohsen Y, et al. Does intraductal breast cancer spread in a segmental distribution? An analysis of residual tumour burden following segmental mastectomy using tumour bed biopsies. Eur J Surg Oncol. 2001;27(1):21–5.PubMedCrossRef

Title: Preoperative Chemotherapy Decreases the Need for Re-Excision of Breast Cancers Between 2 and 4 cm Diameter
Authors: Carla J. Christy, MD
David Thorsteinsson, MD
Baiba J. Grube, MD, MS
Dalliah Black, MD
Maysa Abu-Khalaf, MD
Gina G. Chung, MD
Michael P. DiGiovanna, MD, PhD
Kenneth Miller, MD
Susan A. Higgins, MD
Joanne Weidhaas, MD, PhD
Lyndsay Harris, MD
Fattaneh A. Tavassoli, MD
Donald R. Lannin, MD
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 3/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-008-0268-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative Chemotherapy Decreases the Need for Re-Excision of Breast Cancers Between 2 and 4 cm Diameter

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2009

The Role of Surveillance Chest X-Rays in the Follow-Up of High-Risk Melanoma Patients

Surgical Treatments and Prognoses of Patients with Combined Hepatocellular Carcinoma and Cholangiocarcinoma

Lymph Node Evaluation and Long-Term Survival in Stage II and Stage III Colon Cancer: A National Study

Readmissions Following Pancreaticoduodenectomy for Pancreas Cancer: A Population-Based Appraisal

Evaluation of 47 Soft Tissue Sarcoma Resection Specimens after Isolated Limb Perfusion with TNF-α and Melphalan: Histologically Characterized Improved Margins Correlate with Absence of Recurrences

Sentinel Node Mapping and Skip Metastases in Patients with Early Gastric Cancer