Current situation of breast conserving surgery after neoadjuvant chemotherapy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Linghan ¹ , LIU Mei ¹ , GONG Can ² ,  WANG Xiaodong ¹

1. Department of Breast Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Xiaodong, Email: wxd65112@163.com

Keywords：

breast cancer; neoadjuvant chemotherapy; breast conserving surgery; review

DOI：

10.7507/1007-9424.201712027

Video：

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Objective To explore the tumor shrinking pattern, the image evaluation methods of the residual lesions after neoadjuvant chemotherapy, and the indications, the resection range, the surgical margins, the management of sentinel lymph node biopsy (SLNB) and axillary lymph nodes of breast conserving surgery after neoadjuvant chemotherapy. Methods Domestic and foreign literatures about the breast conserving surgery after neoadjuvant chemotherapy were collected and reviwed. Results Breast conserving surgery after neoadjuvant chemotherapy raised the rate of breast conserving surgery and improved the postoperative life quality of patients, while the overall survival rate had no significant difference compared with mastectomy. Tumor shrinking pattern and its related factors after neoadjuvant chemotherapy remain required further study. At present, the indications for breast conserving surgery after neoadjuvant chemotherapy still mainly refered to that for early stage breast cancer. Resection range was more recognized to the scope of residual tumor lesions after chemotherapy. The margins were more widely accepted as which were without tumor involved. Although there were some controversies about the use of SLNB and the management of axillary lymph nodes based on the results of SLNB in breast conserving surgery after neoadjuvant chemotherapy, it was still considered necessary at the basis of the accurate biopsy technique acquired. Conclusions At present, breast conserving treatment after neoadjuvant chemotherapy is considered safe and effective. However, it is necessary to proceed cautiously under the conditions of adequate communication of local recurrence rate, standardized local treatment, standard postoperative radiotherapy, systemic adjuvant therapy, and regular follow-up.

Citation： ZHANG Linghan, LIU Mei, GONG Can, WANG Xiaodong. Current situation of breast conserving surgery after neoadjuvant chemotherapy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 154-160. doi: 10.7507/1007-9424.201712027 Copy

1.	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): 1539-1545.
2.	Kaufmann M, von Minckwitz G, Mamounas EP, et al. Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol, 2012, 19(5): 1508-1516.
3.	Colleoni M, Viale G, Zahrieh D, et al. Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: a study of preoperative treatment. Clin Cancer Res, 2004, 10(19): 6622-6628.
4.	Krainick-Strobel UE, Lichtenegger W, Wallwiener D, et al. Neoadjuvant letrozole in postmenopausal estrogen and/or progesterone receptor positive breast cancer: a phase Ⅱb/Ⅲ trial to investigate optimal duration of preoperative endocrine therapy. BMC Cancer, 2008, 8: 62.
5.	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.
6.	Takada M, Kataoka A, Toi M, et al. A close association between alteration in growth kinetics by neoadjuvant chemotherapy and survival outcome in primary breast cancer. Int J Oncol, 2004, 25(2): 397-405.
7.	王姝姝. 全乳腺大切片观察乳腺癌新辅助化疗后残留灶形态学变化及部分分子生物学特点研究. 重庆: 第三军医大学, 2010.
8.	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): 2303-2312.
9.	Rajan R, Poniecka A, Smith TL, et al. Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response. Cancer, 2004, 100(7): 1365-1373.
10.	El-Didi MH, Moneer MM, Khaled HM, et al. Pathological assessment of the response of locally advanced breast cancer to neoadjuvant chemotherapy and its implications for surgical management. Surg Today, 2000, 30(3): 249-254.
11.	Chagpar AB, McMasters KM. Trends in mammography and clinical breast examination: a population-based study. J Surg Res, 2007, 140(2): 214-219.
12.	张朝蓬. 乳腺癌新辅助化疗后肿瘤退缩模式的病理大切片研究. 济南: 山东省医学科学院, 2009.
13.	Hylton NM, Blume JD, Bernreuter WK, et al. Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy-results from ACRIN 6657/I-SPY TRIAL. Radiology, 2012, 263(3): 663-672.
14.	周娟, 邢旭东, 李功杰, 等. 动态增强磁共振成像对新辅助化疗后乳腺癌残余病灶的术前评估. 实用放射学杂志, 2012, 28(10): 1553-1556.
15.	Chen JH, Feig B, Agrawal G, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer, 2008, 112(1): 17-26.
16.	Straver ME, Loo CE, Rutgers EJ, et al. MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy. Ann Surg, 2010, 251(4): 701-707.
17.	Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
18.	Kuerer HM, Singletary SE, Buzdar AU, et al. Surgical conservation planning after neoadjuvant chemotherapy for stageⅡ and operable stageⅢ breast carcinoma. Am J Surg, 2001, 182(6): 601-608.
19.	Rouzier R, Extra JM, Carton M, et al. Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery. J Clin Oncol, 2001, 19(18): 3828-3835.
20.	Fisher ER, Sass R, Fisher B. Pathologic findings from the National Surgical Adjuvant Project for Breast Cancers (protocol no. 4). X. Discriminants for tenth year treatment failure. Cancer, 1984, 53(3 Suppl): 712-723.
21.	Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy wih lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med, 1995, 333(22): 1456-1461.
22.	Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy. Cancer, 2005, 103(4): 689-695.
23.	Huang EH, Strom EA, Perkins GH, et al. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score. Int J Radiat Oncol Biol Phys, 2006, 66(2): 352-357.
24.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2017 年版). 中国癌症杂志, 2017, 27(9): 695-759.
25.	郭小毛, 梅欣, 章倩. 局部晚期乳腺癌的治疗进展. 中国癌症杂志, 2006, 16(6): 409-416.
26.	张立宁, 高密华. 新辅助化疗联合保乳手术治疗早期乳腺癌的疗效分析. 临床医药文献电子杂志, 2015, 2(13): 2578.
27.	许春森, 林舜国, 韩晖, 等. 较大乳腺癌新辅助化疗后保乳手术 24 例报告. 中国微创外科杂志, 2008, 8(11): 989-990.
28.	Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference. J Clin Oncol, 2008, 26(5): 791-797.
29.	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): 228-234.
30.	Buchholz TA, Hunt KK, Whitman GJ, et al. Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks. Cancer, 2003, 98(6): 1150-1160.
31.	Boughey JC, Peintinger F, Meric-Bernstam F, et al. Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg, 2006, 244(3): 464-470.
32.	邵志敏, 李俊杰. St. Gallen 国际乳腺癌大会外科新进展和解读. 中华乳腺病杂志(电子版), 2017, 11(4): 198-202.
33.	Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol, 2012, 30(32): 3960-3966.
34.	Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol, 2015, 33(3): 258-264.
35.	Diego EJ, McAuliffe PF, Soran A, et al. Axillary staging after neoadjuvant chemotherapy for breast cancer: a pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes. Ann Surg Oncol, 2016, 23(5): 1549-1553.

1. 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): 1539-1545.
2. Kaufmann M, von Minckwitz G, Mamounas EP, et al. Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol, 2012, 19(5): 1508-1516.
3. Colleoni M, Viale G, Zahrieh D, et al. Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: a study of preoperative treatment. Clin Cancer Res, 2004, 10(19): 6622-6628.
4. Krainick-Strobel UE, Lichtenegger W, Wallwiener D, et al. Neoadjuvant letrozole in postmenopausal estrogen and/or progesterone receptor positive breast cancer: a phase Ⅱb/Ⅲ trial to investigate optimal duration of preoperative endocrine therapy. BMC Cancer, 2008, 8: 62.
5. 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.
6. Takada M, Kataoka A, Toi M, et al. A close association between alteration in growth kinetics by neoadjuvant chemotherapy and survival outcome in primary breast cancer. Int J Oncol, 2004, 25(2): 397-405.
7. 王姝姝. 全乳腺大切片观察乳腺癌新辅助化疗后残留灶形态学变化及部分分子生物学特点研究. 重庆: 第三军医大学, 2010.
8. 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): 2303-2312.
9. Rajan R, Poniecka A, Smith TL, et al. Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response. Cancer, 2004, 100(7): 1365-1373.
10. El-Didi MH, Moneer MM, Khaled HM, et al. Pathological assessment of the response of locally advanced breast cancer to neoadjuvant chemotherapy and its implications for surgical management. Surg Today, 2000, 30(3): 249-254.
11. Chagpar AB, McMasters KM. Trends in mammography and clinical breast examination: a population-based study. J Surg Res, 2007, 140(2): 214-219.
12. 张朝蓬. 乳腺癌新辅助化疗后肿瘤退缩模式的病理大切片研究. 济南: 山东省医学科学院, 2009.
13. Hylton NM, Blume JD, Bernreuter WK, et al. Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy-results from ACRIN 6657/I-SPY TRIAL. Radiology, 2012, 263(3): 663-672.
14. 周娟, 邢旭东, 李功杰, 等. 动态增强磁共振成像对新辅助化疗后乳腺癌残余病灶的术前评估. 实用放射学杂志, 2012, 28(10): 1553-1556.
15. Chen JH, Feig B, Agrawal G, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer, 2008, 112(1): 17-26.
16. Straver ME, Loo CE, Rutgers EJ, et al. MRI-model to guide the surgical treatment in breast cancer patients after neoadjuvant chemotherapy. Ann Surg, 2010, 251(4): 701-707.
17. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
18. Kuerer HM, Singletary SE, Buzdar AU, et al. Surgical conservation planning after neoadjuvant chemotherapy for stageⅡ and operable stageⅢ breast carcinoma. Am J Surg, 2001, 182(6): 601-608.
19. Rouzier R, Extra JM, Carton M, et al. Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery. J Clin Oncol, 2001, 19(18): 3828-3835.
20. Fisher ER, Sass R, Fisher B. Pathologic findings from the National Surgical Adjuvant Project for Breast Cancers (protocol no. 4). X. Discriminants for tenth year treatment failure. Cancer, 1984, 53(3 Suppl): 712-723.
21. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy wih lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med, 1995, 333(22): 1456-1461.
22. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy. Cancer, 2005, 103(4): 689-695.
23. Huang EH, Strom EA, Perkins GH, et al. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score. Int J Radiat Oncol Biol Phys, 2006, 66(2): 352-357.
24. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2017 年版). 中国癌症杂志, 2017, 27(9): 695-759.
25. 郭小毛, 梅欣, 章倩. 局部晚期乳腺癌的治疗进展. 中国癌症杂志, 2006, 16(6): 409-416.
26. 张立宁, 高密华. 新辅助化疗联合保乳手术治疗早期乳腺癌的疗效分析. 临床医药文献电子杂志, 2015, 2(13): 2578.
27. 许春森, 林舜国, 韩晖, 等. 较大乳腺癌新辅助化疗后保乳手术 24 例报告. 中国微创外科杂志, 2008, 8(11): 989-990.
28. Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference. J Clin Oncol, 2008, 26(5): 791-797.
29. 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): 228-234.
30. Buchholz TA, Hunt KK, Whitman GJ, et al. Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks. Cancer, 2003, 98(6): 1150-1160.
31. Boughey JC, Peintinger F, Meric-Bernstam F, et al. Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg, 2006, 244(3): 464-470.
32. 邵志敏, 李俊杰. St. Gallen 国际乳腺癌大会外科新进展和解读. 中华乳腺病杂志(电子版), 2017, 11(4): 198-202.
33. Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol, 2012, 30(32): 3960-3966.
34. Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol, 2015, 33(3): 258-264.
35. Diego EJ, McAuliffe PF, Soran A, et al. Axillary staging after neoadjuvant chemotherapy for breast cancer: a pilot study combining sentinel lymph node biopsy with radioactive seed localization of pre-treatment positive axillary lymph nodes. Ann Surg Oncol, 2016, 23(5): 1549-1553.

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Current situation of breast conserving surgery after neoadjuvant chemotherapy

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