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Postmastectomy morbidity after combination preoperative irradiation and chemotherapy for locally advanced breast cancer

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Abstract

Neoadjuvant therapy for locally advanced breast cancer improves disease control, but the complications of treatment are not well established. The aim of this study was to assess the operative morbidity in 20 consecutive patients with locally advanced, noninflammatory breast cancer treated with preoperative chemotherapy and radiation. Patients received preoperative cyclophosphamide, methotrexate, 5-fluorouracil, prednisone, and tamoxifen (CMFPT) to maximum response followed by concurrent chemotherapy and radiation to the involved breast and regional lymph nodes. Following modified radical mastectomy, chemotherapy was continued for a total of 10 cycles. Disease progressed in 3 of 20 patients (15%). Seventeen patients underwent mastectomy, 4 (24%) of whom demonstrated a pathologic complete response to chemoradiotherapy. Seven patients (41%) developed wound infections, 2 (12%) necrosis, 5 (29%) delayed healing, 2 (12%) upper extremity lymphedema, and 8 (47%) seromas. Postoperative chemotherapy was delayed in 4 (24%) patients. There was no mortality, and hospitalization was for less than 1 week. Only one patient required readmission. Although this treatment regimen is aggressive with attendant morbidity, complications are easily managed and generally do not delay therapy. Treatment modification to further reduce complications may be indicated.

Résumé

La chimiothérapie néoadjuvante améliore l'état local du cancer du sein local avancé. Les complications de ce traitement, cependant, sont encore mal connues. Le but de cette étude a été d'évaluer la morbidité opératoire chez 20 patientes consécutives ayant un cancer du sein avancé, non inflammatoire, traitées par la chimiothérapie et irradiation préopératoires. Les patientes ont reçu une combinaison de cyclophospamide, méthotrexate, 5-fluorouracile, prédnisone et tamoxifène (CMFPT), jusqu'à obtention d'une réponse maximale, suivie de cette même chimiothérapie à dose stable et d'une irradiation du sein et des adénopathies régionales. Après une mastectomie radicale modifiée, la chimiothérapie a été continué pour un total de 10 cycles. Malgré ce, la maladie a continué d'évoluer chez trois des 20 patientes (15%). Dix-sept patientes ont eu une mastectomie, quatre (24%) parmi elles ayant eu une réponse complète anatomopathologique à la chimiothérapie. Sept patientes (41%) ont dévéloppé une infection pariétale, 2 (12%) une nécrose, 5 (29%) ont eu un retard de cicatrisation, 2 (12%), un lymphédème et 8 (47%), une collection séreuse. La chimiothérapie postopératoire a du être différée chez 4 (24%) patientes. Il n'y pas eu de mortalité et aucune patiente n'est restée à l'Hôpital plus d'une semaine. Une seule patiente a nécessité une réhospitalisation. En conclusion, cette modalité thérapeutique est aggressive et comporte une certaine morbidité. Néanmoins, les complications sont d'un traitement rélativement facile et en général, n'interfèrent pas avec la thérapeutique ultérieure. Il faut continuer à chercher à réduire cette morbidité.

Resumen

En tanto que la terapia neoadyuvante para el cáncer mamario localmente avanzado mejora el control de la enfermedad, las complicaciones del tratamiento no están aún bien establecidas. El propósito del presente estudio fue el de evaluar la mortalidad operatoria en 20 pacientes consecutivos con cáncer mamario localmente avanzado, no inflamatorio, tratado con un protocolo de de quimioterapia e irradiación preoperatoria.

Los pacientes recibieron ciclofosfamida preoperatoria, metotrexato, 5-fluoruracil, prednisona y tamoxifén (CMFPT) hasta el nível de maxima respuesta, seguido de quimioterapia y radioterapia concurrente al seno afectado y a los ganglios linfáticos regionales. Realizada la mastectomia radical modificada, se continuó la quimioterapia por un total de 10 ciclos.

La enfermedad continuó progresando en tres de 20 pacientes (15%). Diecisiete pacientes fueron sometidos a mastectomía, cuatro (24%) de los cuales demostraron remisión histopatológica completa a la quimiorradioterapia. Siete (41%) desarrollaron infección de la herida, 2 (12%) necrosis, 5 (29%) cicatrización retardada, 2 (12%) linfedema de la extremidad superior y 8 (47%) seroma. La quimioterapia postoperatoria fue demorada en 4 (24%) de los casos. No se registró mortalidad y no hubo hospitalizaciones de más de una semana. Solo un paciente requirió readmisió.

En conclusión, éste es un tratamiento agresivo que se acompaña de morbilidad. Sin embargo, las complicaciones son de fácil manejo y generalmente no demoran la terapia. Ciertas modificaciones del tratamiento orientadas a reducir aún más las complicaicones pueden estar indicadas.

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Authors and Affiliations

  1. Departments of Surgical Oncology, Radiation Oncology, and Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA

    Edward R. Sauter M.D., Burton L. Eisenberg M.D., F.A.C.S., John P. Hoffman M.D., F.A.C.S., Faith D. Ottery M.D., Ph.D., Marcia C. Boraas M.D., F.A.C.S., Lori J. Goldstein M.D. & Lawrence J. Solin M.D.

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  1. Edward R. Sauter M.D.
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  2. Burton L. Eisenberg M.D., F.A.C.S.
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Sauter, E.R., Eisenberg, B.L., Hoffman, J.P. et al. Postmastectomy morbidity after combination preoperative irradiation and chemotherapy for locally advanced breast cancer. World J. Surg. 17, 237–241 (1993). https://doi.org/10.1007/BF01658934

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