Breast Cancer Research and Treatment

, Volume 136, Issue 3, pp 919–926 | Cite as

Preoperative systemic therapy in locoregional management of early breast cancer: highlights from the Kyoto Breast Cancer Consensus Conference

  • Masakazu Toi
  • John R. Benson
  • Eric P. Winer
  • John F. Forbes
  • Gunter von Minckwitz
  • Mehra Golshan
  • John F. R. Robertson
  • Hironobu Sasano
  • Bernard F. Cole
  • Louis W. C. Chow
  • Mark D. Pegram
  • Wonshik Han
  • Chiun-Sheng Huang
  • Tadashi Ikeda
  • Shotaro Kanao
  • Eun-Sook Lee
  • Shinzaburo Noguchi
  • Shinji Ohno
  • Ann H. Partridge
  • Roman Rouzier
  • Mitsuhiro Tozaki
  • Tomoharu Sugie
  • Akira Yamauchi
  • Takashi Inamoto
Brief Report
First Online:
Received:
Accepted:

Abstract

Data reviewed at the Kyoto Breast Cancer Consensus Conference (KBCCC) showed that preoperative systemic therapy (PST) could optimize surgery through the utilization of information relating to pre- and post-PST tumor stage, therapeutic sensitivity, and treatment-induced changes in the biological characteristics of the tumor. As such, it was noted that the biological characteristics of the tumor, such as hormone receptors, human epidermal growth factor receptor-2, histological grade, cell proliferative activity, mainly defined by the Ki67 labeling index, and the tumor’s multi-gene signature, should be considered in the planning of both systemic and local therapy. Furthermore, the timing of axillary sentinel lymph node diagnosis (i.e., before or after the PST) was also noted to be critical in that it may influence the likelihood of axillary preservation, even in node positive cases. In addition, axillary diagnosis with ultrasound and concomitant fine needle aspiration cytology or core needle biopsy (CNB) was reported to contribute to the construction of a treatment algorithm for patient-specific or individualized axillary surgery. Following PST, planning for breast surgery should therefore be based on tumor subtype, tumor volume and extent, therapeutic response to PST, and patient preference. Nomograms for predicting nodal status and drug sensitivity were also recognized as a tool to support decision-making in the selection of surgical treatment. Overall, review of data at the KBCCC showed that PST increases the likelihood of patients receiving localized surgery and individualized treatment regimens.

Keywords

Breast cancer Preoperative systemic therapy Sentinel lymph node Breast-conserving therapy 
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Notes

Acknowledgments

We would like to express our sincere gratitude to Professor Masahiro Hiraoka, Dr. Michihide Mitsumori, Dr. Hiroshi Ishiguro, Dr. Takayuki Ueno, Ms. Aya Morotomi, Ms. Mihoko Yamamoto, Ms. Chisa Takano, and Mr. David Graham for their assistance with the preparation of this manuscript. We would also like to thank the Commemorative Organization for the Japan World Exposition (1970). The conference was part of a program, “Raising Proficient Oncologists,” organized by the Japanese Ministry of Education, Culture, Sports, Science, and Technology. Finally, we would like to acknowledge the kind support of the Japan Breast Cancer Society.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Masakazu Toi
    • 1
  • John R. Benson
    • 2
  • Eric P. Winer
    • 3
  • John F. Forbes
    • 4
  • Gunter von Minckwitz
    • 5
  • Mehra Golshan
    • 6
  • John F. R. Robertson
    • 7
  • Hironobu Sasano
    • 8
  • Bernard F. Cole
    • 9
  • Louis W. C. Chow
    • 10
  • Mark D. Pegram
    • 11
  • Wonshik Han
    • 12
  • Chiun-Sheng Huang
    • 13
  • Tadashi Ikeda
    • 14
  • Shotaro Kanao
    • 15
  • Eun-Sook Lee
    • 16
  • Shinzaburo Noguchi
    • 17
  • Shinji Ohno
    • 18
  • Ann H. Partridge
    • 3
  • Roman Rouzier
    • 19
  • Mitsuhiro Tozaki
    • 20
  • Tomoharu Sugie
    • 1
  • Akira Yamauchi
    • 21
  • Takashi Inamoto
    • 22
  1. 1.Breast Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.Cambridge Breast Unit, Addenbrooke’s HospitalUniversity of CambridgeCambridgeUK
  3. 3.Breast Oncology Center, Dana-Farber Cancer Institute, Brigham & Women’s Cancer CenterHarvard Medical SchoolBostonUSA
  4. 4.Surgical OncologyUniversity of NewcastleNewcastleAustralia
  5. 5.German Breast GroupNeu-IsenburgGermany
  6. 6.Breast Surgery, Dana-Farber Cancer InstituteBrigham & Women’s Cancer Center, Harvard Medical SchoolBostonUSA
  7. 7.Breast Surgery, Royal Derby HospitalUniversity of NottinghamNottinghamUK
  8. 8.PathologyTohoku University School of MedicineSendaiJapan
  9. 9.College of Engineering and Mathematical SciencesUniversity of VermontBurlingtonUSA
  10. 10.UNIMED Medical InstituteUniversity of Hong KongHong KongHong Kong
  11. 11.Medical Oncology, Miller School of MedicineUniversity of MiamiMiamiUSA
  12. 12.SurgerySeoul National University HospitalSeoulKorea
  13. 13.Surgery, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  14. 14.SurgeryTeikyo UniversityTokyoJapan
  15. 15.Diagnostic RadiologyKyoto University Graduate School of MedicineKyotoJapan
  16. 16.Division of Covergence Technology, Center for Breast Cancer, Research Institute and HospitalNational Cancer CenterGoyang-siSouth Korea
  17. 17.Breast and Endocrine Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
  18. 18.Department of Breast OncologyNational Kyushu Cancer CenterFukuokaJapan
  19. 19.University Pierre et Marie Curie (Paris 6)Tenon HospitalParisFrance
  20. 20.Kameda Medical CenterKamogawaJapan
  21. 21.Breast Surgery, The Tazuke Kofukai Medical Research InstituteKitano HospitalOsakaJapan
  22. 22.Department of Breast SurgeryTenri HospitalNaraJapan

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