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Contents lists available at ScienceDirect
European Journal of Surgical Oncology
Breast conserving therapy after neoadjuvant chemotherapy; data from the Dutch Breast Cancer Audit
Pauline E.R. Spronk a, b, *, Jose H. Volders c, Petrousjka van den Tol c, Carolien H. Smorenburg d, Marie-Jeanne T.F.D. Vrancken Peeters e
a Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
b Department of Research, Dutch Institute for Clinical Auditing (DICA), Leiden, the Netherlands
c Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands
d Department of Medical Oncology, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
e Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
Received in revised form
Breast conserving surgery
Involved margin rate
Introduction: NAC has led to an increase in breast conserving surgery (BCS) worldwide. This study aims to analyse trends in the use of neoadjuvant chemotherapy (NAC) and the impact on surgical outcomes. Methods: We reviewed all records of cT1-4N0-3M0 breast cancer patients diagnosed between July 2011 and June 2016 who have been registered in the Dutch National Breast Cancer Audit (NBCA) (N ¼ 57.177). The surgical outcomes of 'BCS after NAC0 were compared with 'primary BCS0, using a multivariable lo-gistic regression model.
Conclusion: The use of NAC and the incidence of 'BCS after NAC0 increased exponentially in time for all stages of invasive breast cancer in the Netherlands. This nationwide data confirms that Caspofungin 'BCS after NAC0 compared to 'primary BCS0 leads to equal surgical outcomes for cT2 and improved surgical outcomes for cT3 breast cancer. These promising results encourage current developments towards de-escalation of surgical treatment.
© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Neoadjuvant chemotherapy in breast cancer patients has resulted in an increased rate of breast conserving treatment (BCT) consisting of breast conserving surgery (BCS) and radiation treat-ment [1e3]. Due to down-staging of the tumour by NAC, patients who were initially planned for mastectomy could receive BCS.
The advantages of BCS compared to mastectomy obviously include less morbidity and thereby improved aspects of quality of life [3e5]. Another benefit of NAC includes the opportunity to de-
* Corresponding author. Department of surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. E-mail address: [email protected] (P.E.R. Spronk).
escalate surgical treatment of the axilla [6e8]. BCS after NAC in-troduces challenges as identification of original tumour location and monitoring tumour response using imaging [9,10]. The efficacy of NAC to downsize or achieve a pathologic complete response (pCR) has improved due to more efficient targeted drug regimens, and pCR rates of up to 60e80% in the triple negative and HR-/ HER2þ subtypes are now being reached [11,12]. These promising results have led to challenging new trials investigating the potential of non-operative therapy for invasive breast cancer by utilizing accurate image-guided percutaneous biopsy to document patho-logic complete response [13e15].
While improved breast imaging and the promising concept of non-operative therapy in patients that reach pCR after NAC are currently being investigated, surgical management with the
0748-7983/© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
primary goal to remove the (residual) tumour with clear margins is still the standard of care. In the present study, we analyse trends in the surgical performance after NAC for breast cancer in the Netherlands between 2012 and 2016 (1), we describe the surgical outcomes including margins and re-excision rates for BCS after NAC compared to primary BCS (2) and identify prognostic factors associated with involved margins for both groups (3).