Skip to main content
SpringerLink
Log in

A prospective trial of preoperative chemotherapy in resectable breast cancer: Predictors of breast-conservation therapy feasibility

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

Abstract

Background

The role of preoperative chemotherapy for breast cancer is evolving. We initiated a prospective trial of sequential preoperative paclitaxel and doxorubicin-based combination chemotherapy in patients with stage I (tumor>1 cm), II, or IIIA disease and evaluated its effect on breast-conservation therapy (BCT) eligibility.

Methods

Pathology findings for the initial 100 consecutive patients who underwent surgery were analyzed.

Results

The median tumor size at presentation was 2.4 cm, and 39% of patients were deemed eligible for BCT. After chemotherapy, the median tumor size decreased to 1.0 cm (P<.001), and 59% of patients seemed BCT eligible (BCT conversion rate 34% among patients initially assessed as BCT ineligible;P<.001). Final pathology confirmed BCT feasibility in 90% of patients assessed as BCT candidates before surgery. The pathology from mastectomy specimens revealed BCT feasibility in 11 (27%) of 41 patients deemed BCT ineligible. Multivariate analysis revealed lobular histology, multicentricity, and calcifications, but not age, initial tumor size, or nodal status to predict final pathology indicating BCT ineligibility.

Conclusions

Induction chemotherapy improves BCT eligibility for breast cancer patients. Improved breast imaging methods after chemotherapy are necessary to improve accuracy in predicting the feasibility of BCT, especially in patients presenting with diffuse calcifications or multicentricity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hunt KK, Ames FC, Singletary SE, Buzdar AU, Hortobagyi GN. Locally advanced noninflammatory breast cancer.Surg Clin North Am 1996;76:393–410.

    Article  PubMed  CAS  Google Scholar 

  2. Fisher B, Brown A, Mamounas E et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from the National Surgical Adjuvant Breast and Bowel Project B-18.J Clin Oncol 1997;15:2483–93.

    PubMed  CAS  Google Scholar 

  3. Fisher B, Wolmark N, Mamounas E, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer.J Clin Oncol 1998;16:2672–85.

    PubMed  CAS  Google Scholar 

  4. Hortobagyi GN, Singletary SE, McNeese MD. Treatment of locally advanced and inflammatory breast cancer. In: Harris JR, Lippman ME, Morrow M, Hellman S, eds.Diseases of the Breast. Philadelphia: Lippincott-Raven, 1996:585–99.

    Google Scholar 

  5. Wolff AC, Davidson NE. Primary systemic therapy in operable breast cancer.J Clin Oncol 2000;18:1558–69.

    PubMed  CAS  Google Scholar 

  6. McCready DR, Hortobagyi GN, Kau SW, Smith TL, Buzdar AU, Balch CM. The prognostic significance of lymph node metastases after preoperative chemotherapy for locally advanced breast cancer.Arch Surg 1989;124:21–5.

    PubMed  CAS  Google Scholar 

  7. Broadwater JR, Edwards MJ, Kuglen C, Hortobagyi GN, Ames FC, Balch CM. Mastectomy following preoperative chemotherapy.Ann Surg 1991;213:126–9.

    Article  PubMed  CAS  Google Scholar 

  8. Singletary SE, McNeese MD, Hortobagyi GN. Feasibility of breast conservation surgery after induction chemotherapy for locally advanced breast cancer.Cancer 1992;69:2849–52.

    Article  PubMed  CAS  Google Scholar 

  9. Peoples G, Heaton K, Booser D, et al. Breast conservation therapy for large primary and locally advanced breast cancers after induction chemotherapy (abstract No. 25). Society of Surgical Oncology 51st Annual Cancer Symposium, San Diego, CA, March 26–29, 1998.

  10. Bonnadonna G, Veronesi U, Brambilla C, et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more.J Natl Cancer Inst 1990;82:1539–45.

    Article  Google Scholar 

  11. Mauriac L, Durand M, Avril A, Dilhuydy JM. Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm.Ann Oncol 1991;2:347–54.

    PubMed  CAS  Google Scholar 

  12. Mauriac L, MacGrogan G, Avril A, et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up.Ann Oncol 1999;10:47–52.

    Article  PubMed  CAS  Google Scholar 

  13. Semiglazov VF, Topuzov EE, Bavli JL, et al. Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIB-IIIA breast cancer.Ann Oncol 1994; 5:591–5.

    PubMed  CAS  Google Scholar 

  14. Scholl SM, Fourquet A, Asselain B, et al. Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumors considered too large for breast conserving surgery: preliminary results of a randomised trial—S6.Eur J Cancer 1994;30A:645–52.

    Article  PubMed  CAS  Google Scholar 

  15. Scholl SM, Pierga JY, Asselain B, et al. Breast tumour response to primary chemotherapy predicts local and distant control as well as survival.Eur J Cancer 1995;31A:1969–75.

    Article  PubMed  CAS  Google Scholar 

  16. Powles TJ, Hickish TF, Makris A, et al. Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer.J Clin Oncol 1995;13:547–52.

    PubMed  CAS  Google Scholar 

  17. Makris A, Powles TJ, Ashley SE, et al. A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer.Ann Oncol 1998; 9:1179–84.

    Article  PubMed  CAS  Google Scholar 

  18. Kuerer HM, Newman LA, Smith TL et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy.J Clin Oncol 1999;17:460–9.

    PubMed  CAS  Google Scholar 

  19. Buzdar AU, Singletary SE, Theriault RL, et al. Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer.J Clin Oncol 1999;17:3412–7.

    PubMed  CAS  Google Scholar 

  20. Davidson NG, Chick JB, Perren TJ, Campbell N, Thompson JM, Chan YT. A phase II study of single agent paclitaxel in patients at first relapse following initial treatment for breast cancer.Clin Oncol 1996;8:358–62.

    Article  CAS  Google Scholar 

  21. Seidman AD. One-hour paclitaxel via weekly infusion: dose-intensity with enhanced therapeutic index.Oncology 1998;12:19–22.

    PubMed  CAS  Google Scholar 

  22. Winchester DP, Cox JD. Standards for diagnosis and management of invasive breast carcinoma.CA Cancer J Clin 1998;48:83–107.

    PubMed  CAS  Google Scholar 

  23. Abraham DC, Jones RC, Jones SE, et al. Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging.Cancer 1996;78:91–100.

    Article  PubMed  CAS  Google Scholar 

  24. Avril N, Rose CA, Schelling M, et al. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations.J Clin Oncol 2000;18:3495–502.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blyd, Box 444, 770300-4009, Houston, TX

    Lisa A. Newman MD, S. Eva Singletary MD, Henry M. Kuerer MD, PhD, Frederick C. Ames MD, Merrick I. Ross MD & Kelly K. Hunt MD (Associate Professor of Surgery)

  2. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

    Aman U. Buzdar MD

  3. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

    Thomas Buchholz MD

Authors
  1. Lisa A. Newman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aman U. Buzdar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Eva Singletary MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henry M. Kuerer MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Buchholz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frederick C. Ames MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Merrick I. Ross MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kelly K. Hunt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kelly K. Hunt MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Newman, L.A., Buzdar, A.U., Singletary, S.E. et al. A prospective trial of preoperative chemotherapy in resectable breast cancer: Predictors of breast-conservation therapy feasibility. Annals of Surgical Oncology 9, 228–234 (2002). https://doi.org/10.1007/BF02573059

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02573059

Key Words

Search

Navigation