Clinical application of oncoplastic surgery in breast-conserving surgery after neoadjuvant chemotherapy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LÜ Minhao , QIAO Jianghua , LI Juntao , JIAO Dechuang , TIAN Peiqi , LIU Zhenzhen ,  CHEN Xiuchun

Breast Diseases Center, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, P. R. China;

Corresponding author：

CHEN Xiuchun, Email: cxc701024@163.com

Keywords：

breast cancer; neoadjuvant chemotherapy; oncoplastic surgery; breast-conserving therapy

DOI：

10.7507/1007-9424.201903044

Video：

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Objective To explore the clinical application of oncoplastic surgery in breast-conserving surgery after neoadjuvant chemotherapy.Methods From May 2016 to May 2018, 32 breast cancer patients (cT2–3N0–3M0) who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept breast-conserving surgery after NAC in the Henan Tumor Hospital were enrolled into the retrospective study. These patients were originally unable to perform traditional breast conserving surgery because of the size or location of the tumor. We observed the success rate, safety and cosmetic effects of breast-conserving therapy, which were applicated of tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery.Results In this study, after neoadjuvant chemotherapy, 31 patients achieved CR or PR, and 1 patient had SD. All 32 patients underwent breast-conserving surgery successfully, 3 patients underwent breast-conserving combined with volume replacement, and 29 patients underwent breast-conserving combined with volume displacement. One patient was not satisfied with the cosmetic effects, the other patients were satisfied or basically satisfied with the cosmetic effects. The median follow-up was 18 months (5–24 months), and no local recurrence or distant metastasis was found in 32 patients.Conclusions By tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery, we can make some patients who are originally not suitable for breast conserving due to tumor size and tumor location succeed in breast-conserving therapy, and the safety and cosmetic effect are basically satisfied.

Citation： LÜ Minhao, QIAO Jianghua, LI Juntao, JIAO Dechuang, TIAN Peiqi, LIU Zhenzhen, CHEN Xiuchun. Clinical application of oncoplastic surgery in breast-conserving surgery after neoadjuvant chemotherapy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(6): 678-684. doi: 10.7507/1007-9424.201903044 Copy

1.	van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
2.	Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project. J Clin Oncol, 1998, 16(2): 441-452.
3.	Bonadonna G, Veronesi U, Brumbilla 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.
4.	Clough KB, Lewis JS, Couturand B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg, 2003, 237(1): 26-34.
5.	Haloua MH, Krekel NM, Winters HA, et al. A systematic review of oncoplastic breast-conserving surgery current weaknesses and future prospects. Ann Surg, 2013, 257(4): 609-620.
6.	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): 695-760.
7.	Bogaerts J, Ford R, Sargent D, et al. Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer, 2009, 45(2): 248-260.
8.	Ogston KN, Miller ID, Payne S, et al. A new histological grading system to assess response of breast cancers to primary chemo-therapy: prognostic significance and survival. Breast, 2003, 12(5): 320-327.
9.	Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med, 2017, 376(22): 2147-2159.
10.	von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med, 2019, 380(7): 617-628.
11.	沢井清司, 中嶋啓雄, 市原周, 等. 乳房温存療法の切除範囲と術後の整容性に関する研究(2002-2003). 第8回日本乳癌学会研究, 2004.
12.	师金, 梁迪, 李道娟, 等. 全球女性乳腺癌流行情况研究. 中国肿瘤, 2017, 26(9): 683-690.
13.	Huang Z, Wen W, Zheng Y, et al. Breast cancer incidence and mortality: trends over 40 years among women in Shanghai, China. Ann Oncol, 2016, 27(6): 1129-1134.
14.	隗立兵, 康骅, 海涛, 等. 老年乳腺癌140例的临床特点和治疗. 中国老年学杂志, 2011, 31(15): 2858-2860.
15.	陈盛, 邵志敏. 乳腺肿瘤外科治疗策略与进展. 中国实用外科杂志, 2015, 35(7): 693-696.
16.	唐金海, 姚宇锋. 早期乳腺癌的诊断和外科治疗进展. 中国普外基础与临床杂志, 2011, 18(9): 913-916.
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.	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.
19.	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.
20.	Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy. Cancer, 2005, 103(4): 689-695.
21.	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.
22.	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.
23.	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.
24.	Yang JD, Bae SG, Chung HY, et al. The usefulness of oncoplastic volume displacement techniques in the superiorly located breast cancers for Korean patients with small to moderate-sized breasts. Ann Plast Surg, 2011, 67(5): 474-480.
25.	Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol, 2005, 6(3): 145-157.
26.	Down SK, Jha PK, Burger A, et al. Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer. Breast J, 2013, 19(1): 56-63.
27.	Driul L, Bernardi S, Bertozzi S, et al. New surgical trends in breast cancer treatment: conservative interventions and oncoplastic breast surgery. Minerva Ginecol, 2013, 65(3): 289-296.
28.	Dogan L, Gulcelik MA, Karaman N, et al. Oncoplastic surgery in surgical treatment of breast cancer: is the timing of adjuvant treatment affected? Clin Breast Cancer, 2013, 13(3): 202-205.
29.	Yang JD, Lee JW, Cho YK, et al. Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 1): volume displacement. J Breast Cancer, 2012, 15(1): 1-6.
30.	Tenofsky PL, Dowell P, Topalovski T, et al. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg, 2014, 207(3): 398-402.
31.	Curigliano G, Burstein HJ, P Winer E, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2017, 28(8): 1700-1712.
32.	张玲菡, 柳梅, 龚灿, 等. 新辅助化疗后乳腺癌保乳手术问题现状. 中国普外基础与临床杂志, 2018, 25(2): 154-160.
33.	杨涛, 王永胜. 乳腺癌新辅助化疗后局部区域外科处理进展. 中国普外基础与临床杂志, 2014, 21(5): 583-588.
34.	曹旭晨. 整形保乳手术--乳腺外科个体化治疗的新方向. 中国普外基础与临床杂志, 2013, 20(8): 838-841.
35.	朱江, 康骅. 乳腺癌保乳手术中乳房缺损的修复方法. 中国普外基础与临床杂志, 2012, 19(7): 799-804.
36.	Mazouni C, Naveau A, Kane A, et al. The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy. Breast, 2013, 22(6): 1189-1193.
37.	Cho JH, Park JM, Park HS, et al. Oncologic safety of breast-conserving surgery compared to mastectomy in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer. J Surg Oncol, 2013, 108(8): 531-536.
38.	Pennery E. The role of endocrine therapies in reducing risk of recurrence in postmenopausal woman with hormone receptor-positive breast cancer. Eur J Oncol Nurs, 2008, 12(3): 233-243.
39.	Behm EC, Beckmann KR, Dahlstrom JE, et al. Surgical margins and risk of locoregional recurrence in invasive breast cancer: an analysis of 10-year data from the Breast Cancer Treatment Quality Assurance Project. Breast, 2013, 22(5): 839-844.
40.	EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effects of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 woman in 22 randomized trials. Lancet, 2014, 383(9935): 2127-2135.

1. van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
2. Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project. J Clin Oncol, 1998, 16(2): 441-452.
3. Bonadonna G, Veronesi U, Brumbilla 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.
4. Clough KB, Lewis JS, Couturand B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg, 2003, 237(1): 26-34.
5. Haloua MH, Krekel NM, Winters HA, et al. A systematic review of oncoplastic breast-conserving surgery current weaknesses and future prospects. Ann Surg, 2013, 257(4): 609-620.
6. 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): 695-760.
7. Bogaerts J, Ford R, Sargent D, et al. Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer, 2009, 45(2): 248-260.
8. Ogston KN, Miller ID, Payne S, et al. A new histological grading system to assess response of breast cancers to primary chemo-therapy: prognostic significance and survival. Breast, 2003, 12(5): 320-327.
9. Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med, 2017, 376(22): 2147-2159.
10. von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med, 2019, 380(7): 617-628.
11. 沢井清司, 中嶋啓雄, 市原周, 等. 乳房温存療法の切除範囲と術後の整容性に関する研究(2002-2003). 第8回日本乳癌学会研究, 2004.
12. 师金, 梁迪, 李道娟, 等. 全球女性乳腺癌流行情况研究. 中国肿瘤, 2017, 26(9): 683-690.
13. Huang Z, Wen W, Zheng Y, et al. Breast cancer incidence and mortality: trends over 40 years among women in Shanghai, China. Ann Oncol, 2016, 27(6): 1129-1134.
14. 隗立兵, 康骅, 海涛, 等. 老年乳腺癌140例的临床特点和治疗. 中国老年学杂志, 2011, 31(15): 2858-2860.
15. 陈盛, 邵志敏. 乳腺肿瘤外科治疗策略与进展. 中国实用外科杂志, 2015, 35(7): 693-696.
16. 唐金海, 姚宇锋. 早期乳腺癌的诊断和外科治疗进展. 中国普外基础与临床杂志, 2011, 18(9): 913-916.
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. 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.
19. 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.
20. Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy. Cancer, 2005, 103(4): 689-695.
21. 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.
22. 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.
23. 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.
24. Yang JD, Bae SG, Chung HY, et al. The usefulness of oncoplastic volume displacement techniques in the superiorly located breast cancers for Korean patients with small to moderate-sized breasts. Ann Plast Surg, 2011, 67(5): 474-480.
25. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol, 2005, 6(3): 145-157.
26. Down SK, Jha PK, Burger A, et al. Oncological advantages of oncoplastic breast-conserving surgery in treatment of early breast cancer. Breast J, 2013, 19(1): 56-63.
27. Driul L, Bernardi S, Bertozzi S, et al. New surgical trends in breast cancer treatment: conservative interventions and oncoplastic breast surgery. Minerva Ginecol, 2013, 65(3): 289-296.
28. Dogan L, Gulcelik MA, Karaman N, et al. Oncoplastic surgery in surgical treatment of breast cancer: is the timing of adjuvant treatment affected? Clin Breast Cancer, 2013, 13(3): 202-205.
29. Yang JD, Lee JW, Cho YK, et al. Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 1): volume displacement. J Breast Cancer, 2012, 15(1): 1-6.
30. Tenofsky PL, Dowell P, Topalovski T, et al. Surgical, oncologic, and cosmetic differences between oncoplastic and nononcoplastic breast conserving surgery in breast cancer patients. Am J Surg, 2014, 207(3): 398-402.
31. Curigliano G, Burstein HJ, P Winer E, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2017, 28(8): 1700-1712.
32. 张玲菡, 柳梅, 龚灿, 等. 新辅助化疗后乳腺癌保乳手术问题现状. 中国普外基础与临床杂志, 2018, 25(2): 154-160.
33. 杨涛, 王永胜. 乳腺癌新辅助化疗后局部区域外科处理进展. 中国普外基础与临床杂志, 2014, 21(5): 583-588.
34. 曹旭晨. 整形保乳手术--乳腺外科个体化治疗的新方向. 中国普外基础与临床杂志, 2013, 20(8): 838-841.
35. 朱江, 康骅. 乳腺癌保乳手术中乳房缺损的修复方法. 中国普外基础与临床杂志, 2012, 19(7): 799-804.
36. Mazouni C, Naveau A, Kane A, et al. The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy. Breast, 2013, 22(6): 1189-1193.
37. Cho JH, Park JM, Park HS, et al. Oncologic safety of breast-conserving surgery compared to mastectomy in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer. J Surg Oncol, 2013, 108(8): 531-536.
38. Pennery E. The role of endocrine therapies in reducing risk of recurrence in postmenopausal woman with hormone receptor-positive breast cancer. Eur J Oncol Nurs, 2008, 12(3): 233-243.
39. Behm EC, Beckmann KR, Dahlstrom JE, et al. Surgical margins and risk of locoregional recurrence in invasive breast cancer: an analysis of 10-year data from the Breast Cancer Treatment Quality Assurance Project. Breast, 2013, 22(5): 839-844.
40. EBCTCG (Early Breast Cancer Trialists' Collaborative Group), McGale P, Taylor C, et al. Effects of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 woman in 22 randomized trials. Lancet, 2014, 383(9935): 2127-2135.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical application of oncoplastic surgery in breast-conserving surgery after neoadjuvant chemotherapy

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