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Breast surgery after neoadjuvant systemic therapy.

Kate R Pawloski1, Andrea V Barrio1

  • 1Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Translational Breast Cancer Research : a Journal Focusing on Translational Research in Breast Cancer
|May 16, 2024
PubMed
Summary
This summary is machine-generated.

Neoadjuvant systemic therapy (NST) helps shrink operable breast cancer tumors, increasing eligibility for breast-conserving surgery (BCS). This approach is safe and effective across various subtypes, even without a complete response.

Keywords:
Neoadjuvant chemotherapy (NAC)breast-conserving surgery (BCS)downstagingneoadjuvant endocrine therapy (NET)

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Area of Science:

  • Oncology
  • Breast Cancer Research
  • Surgical Oncology

Background:

  • Neoadjuvant systemic therapy (NST) is utilized for operable breast cancer to reduce tumor size, facilitating breast-conserving surgery (BCS).
  • Pathologic complete response (pCR) rates are highest in triple-negative and HER2-positive breast cancers, but not essential for BCS eligibility.
  • Neoadjuvant endocrine therapy (NET) is an alternative to neoadjuvant chemotherapy (NAC) for HR+/HER2- postmenopausal patients desiring breast conservation.

Purpose of the Study:

  • To evaluate the efficacy and safety of neoadjuvant systemic therapy (NST) in downstaging operable breast cancer for breast-conserving surgery (BCS).
  • To compare the rates of conversion to BCS eligibility following neoadjuvant chemotherapy (NAC) versus neoadjuvant endocrine therapy (NET).
  • To assess the oncologic safety and local recurrence (LR) rates of BCS after NST.

Main Methods:

  • Review of prospective trials investigating the outcomes of neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy (NET) for operable breast cancer.
  • Analysis of breast pathologic complete response (pCR) rates and conversion to breast-conserving surgery (BCS) eligibility across different breast cancer subtypes.
  • Evaluation of local recurrence (LR) rates in patients undergoing breast-conserving surgery (BCS) after NST, emphasizing the importance of surgical margins.

Main Results:

  • Neoadjuvant systemic therapy (NST) effectively downstages primary breast tumors, increasing rates of breast-conserving surgery (BCS) eligibility across all receptor subtypes.
  • Conversion to BCS eligibility is high with both neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy (NET), with similar rates observed.
  • Oncologic safety of BCS after NAC and NET is established, with acceptably low local recurrence (LR) rates when negative surgical margins are achieved.

Conclusions:

  • Neoadjuvant systemic therapy (NST) is a safe and effective strategy to enable breast-conserving surgery (BCS) for operable breast cancer patients.
  • Achieving a complete pathologic response is not a prerequisite for successful downstaging and avoiding mastectomy.
  • Ongoing research explores omitting surgery in select cases, but the risk of missing residual disease currently limits this approach.