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Impact of Progression During Neoadjuvant Chemotherapy on Surgical Management of Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although neoadjuvant chemotherapy (NCT) is standard therapy for locally advanced breast cancer, it remains controversial for early-stage disease due to concerns that disease progression may make breast-conservation therapy (BCT), or even operability, impossible. The goal of this study was to determine the impact of disease progression during NCT on surgical management.

Methods

We reviewed clinicopathological data on patients who received NCT for stage I-III breast cancer from 1994 to 2007. Chemotherapy regimens were anthracycline- and/or taxane-based as determined by the treating medical oncologist.

Results

Of 1,928 patients who received NCT, 1,762 (91%) had a partial or complete response, 107 (6%) had stable disease (SD), and 59 (3%) progressed (PD) while receiving at least one regimen. Of the patients with progressive disease, 40 (68%) patients underwent mastectomy, 12 (20%) underwent BCT, and 7 (12%) did not undergo surgery. In patients who underwent mastectomy, only three (8%) were BCT candidates before progression. Overall, disease progression changed the operative plan in 11 (0.5%) patients: 3 developed distant metastasis, 2 developed clinical lymphadenopathy, 3 required mastectomy instead of BCT, 2 became inoperable, and 1 required flap closure.

Conclusions

Disease progression while receiving NCT is infrequent (3%), but early identification may allow for change to other, potentially beneficial, therapeutic interventions. Patients with breast cancer who receive NCT should be evaluated frequently for response to therapy. Overall, progression during NCT changes the surgical management in a small proportion of patients.

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Acknowledgment

Supported by National Institutes of Health T32 Institutional Research Training Grant (CA09599; F.M.-B. and A.S.C.), Susan G. Komen for the Cure grant (KG090341; A.M.G.-A.) and by the National Institutes of Health through M.D. Anderson’s Cancer Center Support Grant CA016672.

Conflict of Interest

None.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Abigail S. Caudle MD, Kelly K. Hunt MD, Henry M. Kuerer MD, Elizabeth A. Mittendorf MD & Funda Meric-Bernstam MD

  2. Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Ana M. Gonzalez-Angulo MD, Lajos Pusztai MD & Gabriel N. Hortobagyi MD

Authors
  1. Abigail S. Caudle MD
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  2. Ana M. Gonzalez-Angulo MD
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  3. Kelly K. Hunt MD
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  4. Lajos Pusztai MD
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  5. Henry M. Kuerer MD
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  6. Elizabeth A. Mittendorf MD
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  7. Gabriel N. Hortobagyi MD
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  8. Funda Meric-Bernstam MD
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Corresponding author

Correspondence to Funda Meric-Bernstam MD.

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Caudle, A.S., Gonzalez-Angulo, A.M., Hunt, K.K. et al. Impact of Progression During Neoadjuvant Chemotherapy on Surgical Management of Breast Cancer. Ann Surg Oncol 18, 932–938 (2011). https://doi.org/10.1245/s10434-010-1390-8

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  • DOI: https://doi.org/10.1245/s10434-010-1390-8

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