The surgical management of patients who achieve a complete pathological response after primary chemotherapy for locally advanced breast cancer
The surgical management of patients who achieve a complete pathological response after primary chemotherapy for locally advanced breast cancer
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DOI：
10.1016/j.ejso.2006.12.006
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发表时间：
2007-10-01
期刊：
影响因子：
3.8
通讯作者：
Sauven, P.
中科院分区：
文献类型：
--
作者：
Clouth, B.;Chandrasekharan, S.;Sauven, P.
目的：探讨微创手术在局部晚期乳腺癌(LABC)患者中的作用，评价局部复发(LRR)、无瘤生存率(DFS)和总生存率(OS)。方法：2000年1月至2005年4月，101例局部晚期乳腺癌(T2、T3、NO或N1、MO)患者接受PC治疗。先用阿霉素和环磷酰胺治疗4个周期(100例)，然后用紫杉醇治疗4个周期(91例)。后PC手术包括多次核心活检和腋窝清扫，患者的临床和放射学反应完全。如果聚合酶链式反应被确认，则不再进行进一步的乳房手术。其余患者接受保乳手术或乳房切除及腋窝清扫术。所有患者均接受辅助放射治疗。结果：60%的患者保乳。总体而言，20名患者实现了聚合酶链式反应，其中16名仅通过核心活检得到确认。所有患者均获得平均33.5个月的随访(95%可信区间为30.3~36.7)。有10例局部复发，其中4例在乳房切除术后复发，4例在广泛切除后复发，2例在核心活检后复发。DFS差异无统计学意义(卡方=0。18；p=0.67)或OS(x~2=0.67；p=0.41)。结论：这些预后不良的患者的局部复发率与其他报道的患者相似，但高于我们以前报道的按相同方案治疗的患者。因此，我们目前的管理包括治疗前标记和随后的手术切除。(C)2006爱思唯尔有限公司。保留所有权利。
Aims: Our aim was to investigate the role of minimal surgery in patients with locally advanced breast cancer (LABC) who achieve a complete pathological (pCR) response to primary chemotherapy (PC) and evaluate subsequent local recurrence (LRR), disease free survival (DFS) and overall survival (OS).Methods: Between January 2000 and April 2005, 101 patients with operable LABC (T2, T3, NO or N1, MO) who were not suitable for conservation surgery were treated with PC. Patients were treated with doxorubicin and cyclophosphamide for four cycles (100 patients) then four cycles with paclitaxel (91 patients). Post-PC surgery consisted of multiple core biopsies and axillary clearance for patients with a complete clinical and radiological response. If a pCR was confirmed no further breast surgery was performed. The remaining patients were treated with breast conserving surgery or mastectomy and axillary clearance as appropriate. Adjuvant radiotherapy was given to all patients.Results: Breast conservation was possible in 60% of patients. Overall, 20 patients achieved a pCR of which 16 were confirmed on core biopsies alone. All patients were followed-up for a mean of 33.5 months (95% CI, 30.3-36.7). There were 10 local recurrences, four following mastectomy, four after wide excision and two after core biopsies. There was no difference in DFS (chi square = 0. 18; p = 0.67) or OS (chi square = 0.67; p = 0.41) between patients achieving a pCR and the remainder.Conclusions: The local recurrence rate of these poor prognosis patients is similar to other reported series but higher than in our previously reported series of patients managed according to the same protocol. Our current management therefore now includes pre-treatment marking and Subsequent surgical excision. (C) 2006 Elsevier Ltd. All rights reserved.