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Impact of wait time from neoadjuvant chemotherapy to surgery in breast cancer: Does time to surgery affect patient outcomes?

Time from Neoadjuvant Chemotherapy to Surgery

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Abstract

Purpose

The optimal time interval from neoadjuvant chemotherapy (NAC) to surgery in patients with breast cancer has not been established. We investigated whether different time intervals impact the rate of pathologic complete response (pCR), disease free survival (DFS), overall survival (OS), surgical complications, and rates of conversion from mastectomy to breast conserving surgery (BCS) in this population.

Methods

We identified patients who received NAC at the BC Cancer Agency followed by surgery from May 2012 to April 2018. Patients were grouped based on time interval between NAC and surgery: < 4 weeks, 4–8 weeks, and > 8 weeks. Kaplan Meier method was used to estimate DFS and OS. Rates of pCR between the time intervals were also compared.

Results

Of the 343 patients, 78 (22.8%) received surgery < 4 weeks, 233 (67.9%) received surgery between 4–8 weeks, and 32 (9.3%) received surgery > 8 weeks after NAC, with a median time to surgery (TTS) of 5.0 weeks. pCR was observed in 32.1%, 32.2%, and 28.1%, respectively (p = 0.90). Median follow-up time was 3.3 years. The 5-year DFS was 76%, 78%, and 70% (p = 0.89), respectively. The 5-year OS was 83%, 82%, and 78% (p = 0.33), respectively. No statistically significant differences were seen in surgical complications (p = 0.90), or rates of conversion from mastectomy to BCS (p = 0.19).

Conclusions

There were no statistically significant differences in pCR, DFS, OS, surgical complications, and rates of conversion from mastectomy to BCS, among breast cancer patients receiving surgery < 4 weeks, 4–8 weeks, or > 8 weeks after the last dose of NAC.

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Acknowledgements

We would like to acknowledge the neoadjuvant breast cancer database team at the BC Cancer Agency Vancouver Centre, and all patients undergoing neoadjuvant breast cancer treatment at the BC Cancer Agency.

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Authors and Affiliations

  1. BC Cancer Agency, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada

    Valerie Lai, Omar Hajjaj, Dan Le, Aria Shokoohi, Stephen Chia & Christine Simmons

  2. University of British Columbia, Vancouver, Canada

    Valerie Lai, Dan Le, Aria Shokoohi, Stephen Chia & Christine Simmons

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  1. Valerie Lai
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  2. Omar Hajjaj
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  3. Dan Le
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  6. Christine Simmons
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Correspondence to Christine Simmons.

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Lai, V., Hajjaj, O., Le, D. et al. Impact of wait time from neoadjuvant chemotherapy to surgery in breast cancer: Does time to surgery affect patient outcomes?. Breast Cancer Res Treat 184, 755–762 (2020). https://doi.org/10.1007/s10549-020-05894-x

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  • DOI: https://doi.org/10.1007/s10549-020-05894-x

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