Can we predict local recurrence in breast conserving surgery after neoadjuvant chemotherapy?

Abstract 

Background

One of the benefits of neoadjuvant chemotherapy (NAC) is its ability to convert patients ineligible for breast conservative treatment (BCT) to be candidates for this treatment, although questions have been raised regarding the effectiveness of BCT in terms of loco-regional recurrence (LRR). The objective of this study is to evaluate LRR in this group and the influence of tumor characteristics in recurrence.

Material and Methods

Between 1996 and 2007, 137 patients were treated with BCT after NAC at our Service. After completion of NAC a multidisciplinary team evaluated the cases eligible for BCT. All patients treated with BCT had negative margins and received radiation therapy. Risk factors associated with local recurrence were analyzed using Kaplan–Meier survival curves and long-rang test.

Results

Information was obtained in 121 patients. Median age was 54 years old (SD: 12 years). At a median follow-up of 35 months (range, 18–87 months), 6 (4.95%) patients developed an LRR, with an accumulative incidence at 5 years of 7.3% (95% CI: 0.4–14.1%) and at 10 years of 11.5% (95% CI: 2.8–20.1%). Overall survival at 5 and 10 years was 94.8% (95% CI: 90.9–98.6%) and 82.3% (95% CI: 67.3–97.2%) respectively. Tumor size (T3) (p < 0.001) and pathological stage (Stage III) (p = 0.001) after surgery were strongly associated with LRR.

Conclusions

The results of this study confirm that BCT is an effective treatment in patients with NAC. Tumor size and pathological stage after systemic treatment influence loco-regional recurrence in patients with BCT.

Keywords: Breast cancer, Neoadjuvant therapy, Conservative surgery, Local recurrence, Loco-regional recurrence