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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2021

01-11-2021 | Magnetic Resonance Imaging | Breast Oncology

Breast-Conserving Therapy in Patients with cT3 Breast Cancer with Good Response to Neoadjuvant Systemic Therapy Results in Excellent Local Control: A Comprehensive Cancer Center Experience

Authors: Marieke E. M. van der Noordaa, MD, Ileana Ioan, MD, Emiel J. Rutgers, MD, PhD, Erik van Werkhoven, MSc, Claudette E. Loo, MD, PhD, Rosie Voorthuis, MD, Jelle Wesseling, MD, PhD, Japke van Urk, MD, PhD, Terry Wiersma, MD, Vincent Dezentje, MD, PhD, Marie-Jeanne T. F. D. Vrancken Peeters, MD, PhD, Frederieke H. van Duijnhoven, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2021

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Abstract

Background

Many cT3 breast cancer patients are treated with mastectomy, regardless of response to neoadjuvant systemic therapy (NST). We evaluated local control of cT3 patients undergoing breast-conserving therapy (BCT) based on magnetic resonance imaging (MRI) evaluation post-NST. In addition, we analyzed predictive characteristics for positive margins after breast-conserving surgery (BCS).

Methods

All cT3 breast cancer patients who underwent BCS after NST between 2002 and 2015 at the Netherlands Cancer Institute were included. Local recurrence-free interval (LRFI) was estimated using the Kaplan–Meier method, and predictors for positive margins were analyzed using univariable analysis and multivariable logistic regression.

Results

Of 114 patients undergoing BCS post-NST, 75 had negative margins, 16 had focally positive margins, and 23 had positive margins. Of those with (focally) positive margins, 12 underwent radiotherapy, 6 underwent re-excision, and 21 underwent mastectomy. Finally, 93/114 patients were treated with BCT (82%), with an LRFI of 95.9% (95% confidence interval [CI] 91.5–100%) after a median follow-up of 7 years. Predictors for positive margins in univariable analysis were hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) subtype, lobular carcinoma, and non-mass enhancement (NME) on pre-NST MRI. MRI response was not correlated to positive margins. In multivariable regression, the odds of positive margins were decreased in patients with HER2-positive (HER2+; odds ratio [OR] 0.27, 95% CI 0.10–0.73; p = 0.01) and TN tumors (OR 0.17, 95% CI 0.03–0.82; p = 0.028). A trend toward positive margins was observed in patients with NME (OR 2.38, 95% CI 0.98–5.77; p = 0.055).

Conclusion

BCT could be performed in 82% of cT3 patients in whom BCT appeared feasible on post-NST MRI. Local control in these patients was excellent. In those patients with HR+/HER2− tumors, NME on MRI, or invasive lobular carcinoma, the risk of positive margins should be considered preoperatively.
Appendix
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Metadata
Title
Breast-Conserving Therapy in Patients with cT3 Breast Cancer with Good Response to Neoadjuvant Systemic Therapy Results in Excellent Local Control: A Comprehensive Cancer Center Experience
Authors
Marieke E. M. van der Noordaa, MD
Ileana Ioan, MD
Emiel J. Rutgers, MD, PhD
Erik van Werkhoven, MSc
Claudette E. Loo, MD, PhD
Rosie Voorthuis, MD
Jelle Wesseling, MD, PhD
Japke van Urk, MD, PhD
Terry Wiersma, MD
Vincent Dezentje, MD, PhD
Marie-Jeanne T. F. D. Vrancken Peeters, MD, PhD
Frederieke H. van Duijnhoven, MD, PhD
Publication date
01-11-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-09865-4

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