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Effect of time to breast cancer surgery after neoadjuvant chemotherapy on survival outcomes

Breast Cancer Research and Treatment volume 186, pages 7–13 (2021)Cite this article

Abstract

Background

Neoadjuvant chemotherapy (NACT) is a cornerstone in managing breast cancer. There is no defined consensus on the optimal time between NACT and surgery. We analyze the effect of time between the end of NACT and surgery on overall survival (OS) and disease-free survival (DFS) in breast cancer patients who received NACT followed by surgery.

Methods

This is a retrospective analysis of 468 patients with breast cancer (stage I–III) who received and completed the same regimen of NACT (Anthracyclines and Taxanes B27 protocol) at King Hussein Cancer Center (KHCC) (2006–2014). Patients have been divided into three groups according to the duration between the end of NACT and surgery, <4 weeks, 4–8 weeks and >8 weeks.

Results

Most patients were stages II–III breast cancer with only four patients with stage I. Almost all patients (99%) had either invasive ductal or invasive lobular carcinomas. Adjuvant radiotherapy was given to 96% of patients. Most patients were alive at the time of analysis (84%).

Complete pathological response was achieved in 20% of patients. Local recurrence rate was 6.6% with a median follow up of 3.8 years (interquartile range 0.6–10.9). Analysis showed that the groups had equivalent DFS. However, OS was adversely affected if patients had their surgery after 8 weeks of NACT compared to those who had their surgery between 4 and 8 weeks.

Conclusions

Breast cancer surgery post NACT within the first 8 weeks had no impact on survival. However, surgery after 8 weeks of NACT showed negative impact on OS. Therefore, delaying surgery after 8 weeks is not recommended.

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Data availability

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

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Affiliations

  1. Department of Surgery, King Hussein Cancer Center-KHCC, Amman, Jordan

    Mahmoud Al-Masri, Basim Aljalabneh, Hani Al-Najjar & Tamador Al-Shamaileh

Authors
  1. Mahmoud Al-Masri
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  2. Basim Aljalabneh
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  3. Hani Al-Najjar
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  4. Tamador Al-Shamaileh
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Corresponding author

Correspondence to Mahmoud Al-Masri.

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Conflict of interest

MA-M declares that he has no conflict of interest. BA declares that he has no conflict of interest. HA-N declares that he has no conflict of interest. TA-S declares that he has no conflict of interest. No funding to declare, the authors are employed at KHCC where this research was carried out.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board (IRB) at King Hussein Cancer Center (KHCC) with IRB approval # 17KHCC49.

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Al-Masri, M., Aljalabneh, B., Al-Najjar, H. et al. Effect of time to breast cancer surgery after neoadjuvant chemotherapy on survival outcomes. Breast Cancer Res Treat 186, 7–13 (2021). https://doi.org/10.1007/s10549-020-06090-7

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  • DOI: https://doi.org/10.1007/s10549-020-06090-7

Keywords

  • Neoadjuvant therapy
  • Breast cancer
  • Breast surgery
  • Oncology
  • Chemotherapy