BACKGROUND: Neoadjuvant chemotherapy followed by surgery or radiation therapy, or both, has become the treatment of choice for patients with large-sized resectable carcinoma of the breast in whom mastectomy is the conventional option. Since tumor regression before surgery is considered a favorable prognostic factor, there is still controversy regarding the need to perform an axillary dissection after a good response to systemic induction treatment. STUDY DESIGN: Between February 1990 and December 1993, we conducted a prospective study of 56 consecutive patients receiving high-dose anthracycline-based preoperative chemotherapy for large but potentially resectable carcinoma of the breast. Patients who had a good clinical response to induction systemic treatment received the same chemotherapy in the adjuvant phase, while those whose response was less than optimal received alternative adjuvant chemotherapy regimens. A multivariate analysis was made to evaluate the relative influence on disease-free survival rates of 11 clinicopathologic and treatment-related variables, including clinical response to primary chemotherapy, primary pathological (p-T) staging, and the number of metastatic lymph nodes. RESULTS: At a median follow-up period of 36 months, only the number of metastatic lymph nodes was found to be an independent predictor of relapse. Clinical response to systemic induction treatment and p-T staging did not correlate with prognosis. In the group of patients with axillary lymph node involvement, those who did not respond to preoperative chemotherapy showed a lower relapse rate compared with those who achieved an objective response. CONCLUSIONS: These findings suggest that axillary lymphadenectomy should be considered an important component of the combined modality therapy for patients with large-sized resectable carcinoma of the breast in order to identify subgroups of patients that may benefit from alternative treatments in the adjuvant setting.
BACKGROUND: Neoadjuvant chemotherapy followed by surgery or radiation therapy, or both, has become the treatment of choice for patients with large-sized resectable carcinoma of the breast in whom mastectomy is the conventional option. Since tumor regression before surgery is considered a favorable prognostic factor, there is still controversy regarding the need to perform an axillary dissection after a good response to systemic induction treatment. STUDY DESIGN: Between February 1990 and December 1993, we conducted a prospective study of 56 consecutive patients receiving high-dose anthracycline-based preoperative chemotherapy for large but potentially resectable carcinoma of the breast. Patients who had a good clinical response to induction systemic treatment received the same chemotherapy in the adjuvant phase, while those whose response was less than optimal received alternative adjuvant chemotherapy regimens. A multivariate analysis was made to evaluate the relative influence on disease-free survival rates of 11 clinicopathologic and treatment-related variables, including clinical response to primary chemotherapy, primary pathological (p-T) staging, and the number of metastatic lymph nodes. RESULTS: At a median follow-up period of 36 months, only the number of metastatic lymph nodes was found to be an independent predictor of relapse. Clinical response to systemic induction treatment and p-T staging did not correlate with prognosis. In the group of patients with axillary lymph node involvement, those who did not respond to preoperative chemotherapy showed a lower relapse rate compared with those who achieved an objective response. CONCLUSIONS: These findings suggest that axillary lymphadenectomy should be considered an important component of the combined modality therapy for patients with large-sized resectable carcinoma of the breast in order to identify subgroups of patients that may benefit from alternative treatments in the adjuvant setting.
Authors: Laura S Dominici; Viviana M Negron Gonzalez; Aman U Buzdar; Anthony Lucci; Elizabeth A Mittendorf; Huong T Le-Petross; Gildy V Babiera; Funda Meric-Bernstam; Kelly K Hunt; Henry M Kuerer Journal: Cancer Date: 2010-06-15 Impact factor: 6.860
Authors: H M Kuerer; A A Sahin; K K Hunt; L A Newman; T M Breslin; F C Ames; M I Ross; A U Buzdar; G N Hortobagyi; S E Singletary Journal: Ann Surg Date: 1999-07 Impact factor: 12.969
Authors: D A Cameron; E D Anderson; P Levack; R A Hawkins; T J Anderson; R C Leonard; A P Forrest; U Chetty Journal: Br J Cancer Date: 1997 Impact factor: 7.640
Authors: Bala Basak Oven Ustaalioglu; Mahmut Gumus; Ahmet Bilici; Mesut Seker; Faysal Dane; Taflan Salepci; Tarik Salman; Mehmet Aliustaoglu; Mehmet Eser; Cem Gezen; Mustafa Yaylaci; Nazim Serdar Turhal Journal: Med Oncol Date: 2009-06-02 Impact factor: 3.064
Authors: Sara P Myers; Gillian M Ahrendt; Joanna S Lee; Jennifer G Steiman; Atilla Soran; Ronald R Johnson; Priscilla F McAuliffe; Emilia J Diego Journal: Ann Surg Oncol Date: 2021-06-17 Impact factor: 5.344
Authors: J Schneider; S Gonzalez-Roces; M Pollán; R Lucas; A Tejerina; M Martin; A Alba Journal: Breast Cancer Res Date: 2001-02-01 Impact factor: 6.466
Authors: J Y Pierga; E Mouret; V Diéras; V Laurence; P Beuzeboc; T Dorval; T Palangié; M Jouve; A Vincent-Salomon; S Scholl; J M Extra; B Asselain; P Pouillart Journal: Br J Cancer Date: 2000-12 Impact factor: 7.640
Authors: I P C Buzatto; A Ribeiro-Silva; J M Andrade; H H A Carrara; W A Silveira; D G Tiezzi Journal: Braz J Med Biol Res Date: 2017-01-26 Impact factor: 2.590