Progress of Locoregional Surgery for Breast Cancer Patients after Neoadjuvant Chemotherapy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGTao ,  WANGYong-sheng

Center of Breast Cancer, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, University of Jinan, Jinan 250117, Shandong Province, China;

Corresponding author：

WANGYong-sheng, Email: wangysh2008@aliyun.com

Keywords：

Breast cancer; Neoadjuvant chemotherapy; Breast-conserving therapy; Recurrence rate; Shrinkage mode; Sentinel lymph node biopsy; Axillary lymph node dissection

DOI：

10.7507/1007-9424.20140140

Video：

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Objective To discuss the strategy of locoregional surgery for breast cancer patients after neoadjuvant chemotherapy. Method The pertinent literatures about locoregional surgery concerning breast-conserving therapy, factors of ipsilateral breast tumor recurrence, pathological shrinkage modes of breast primary tumor, and sentinel lymph node biopsy after neoadjuvant chemotherapy were reviewed. Results ①The major benefit of neoadjuvant chemotherapy was to increase the proportion of breast-conserving therapy after downstaging the primary breast tumor. However, the use of breast-conserving therapy after neoadjuvant chemotherapy might remain a higher risk of ipsilateral breast tumor recurrence. It was now widely recognized that the risk factors for ipsilateral breast tumor recurrence were multifocal pattern of residual tumor and pathologic residual tumor larger than 2 cm. The shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy and its relative factors were still unclear. 2 Sentinel lymph node biopsy(SLNB) was feasible either before or after neoadjuvant chemotherapy and approval by SLNB guideline and expert consensus. Patients with a cN0 status could get more benefits from SLNB after neoadjuvant chemotherapy. Although there was a bright future for SLNB as an alternative to ALND for patients with primary cN1 and downstaging to cN0 after neoadjuvant chemotherapy, it needed to obtain the accepted clinical identification rate, false negative rate, as well as similar regional recurrence rate and overall survival as compared to ALND. Conclusions Currently, surgical management is crucial for reducing the locoregional recurrence risk of breast cancer after neoadjuvant chemotherapy, no matter what the clinical and radiographic efficacy of neoadjuvant chemotherapy is. In the era of genomics and SLNB, individual locoregional surgical management could be arrived according to the primary stage and neoadjuvant chemotherapy response.

Citation： YANGTao, WANGYong-sheng. Progress of Locoregional Surgery for Breast Cancer Patients after Neoadjuvant Chemotherapy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(5): 583-588. doi: 10.7507/1007-9424.20140140 Copy

1.	Mauri D, Pavlidis N, Ioannidis JP.Neoadjuvant versus adjuvant systemic treatment in breast cancer:a meta-analysis[J].J Natl Cancer Inst, 2005, 97(3):188-194.
2.	Mieog JS, van der Hage JA, van de Velde CJ.Neoadjuvant chemotherapy for operable breast cancer[J].Br J Surg, 2007, 94(10):1189-1200.
3.	Rastogi P, Anderson SJ, Bear HD, et al.Preoperative chemotherapy:updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27[J].J Clin Oncol, 2008, 26(5):778-785.
4.	Chen AM, Meric-Bernstam F, Hunt KK, et al.Breast conservation after neoadjuvant chemotherapy:the MD Anderson Cancer center experience[J].J Clin Oncol, 2004, 22(12):2303-2312.
5.	Chen AM, Meric-Bernstam F, Hunt KK, et al.Breast conservation after neoadjuvant chemotherapy[J].Cancer, 2005, 103(4):689-695.
6.	Rouzier R, Mathieu MC, Sideris L, et al.Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors[J].Cancer, 2004, 101(5):918-925.
7.	Ishitobi M, Ohsumi S, Inaji H, et al.Ipsilateral breast tumor recurrence (IBTR) in patients with operable breast cancer who undergo breast-conserving treatment after receiving neoadjuvant chemotherapy:risk factors of IBTR and validation of the MD Anderson Prognostic Index[J].Cancer, 2012, 118(18):4385-4393.
8.	Rouzier R, Extra JM, Carton M, et al.Primary chemotherapy for operable breast cancer:incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery[J].J Clin Oncol, 2001, 19(18):3828-3835.
9.	Thomas JS, Julian HS, Green RV, et al.Histopathology of breast carcinoma following neoadjuvant systemic therapy:a common association between letrozole therapy and central scarring[J].Histopathology, 2007, 51(2):219-226.
10.	Wang S, Zhang Y, Yang X, et al.Shrink pattern of breast cancer after neoadjuvant chemotherapy and its correlation with clinical pathological factors[J].World J Surg Oncol, 2013, 11(1):166.
11.	Yang T, Zhang ZP, Liu G, et al.Pathological shrinkage modes of the breast primary tumor after neoadjuvant chemotherapy with part-mount sub-serial section and three-dimensional reconstruction technique[C].3rd International Breast Cancer Symposium.Korea:Korean Breast Cancer Society, 2014:282-283.
12.	Bear HD, Anderson S, Brown A, et al.The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide:preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27[J].J Clin Oncol, 2003, 21(22):4165-4174.
13.	van Deurzen CH, Vriens BE, Tjan-Heijnen VC, et al.Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients:a systematic review[J].Eur J Cancer, 2009, 45(18):3124-3130.
14.	Kelly AM, Dwamena B, Cronin P, et al.Breast cancer sentinel node identification and classification after neoadjuvant chemotherapy-systematic review and meta analysis[J].Acad Radiol, 2009, 16(5):551-563.
15.	Kim T, Giuliano AE, Lyman GH.Lymphatic mapping and sent inel lymph node biopsy in early-stage breast carcinoma:a meta analysis[J].Cancer, 2006, 106(1):4-16.
16.	Buchholz TA, Lehman CD, Harris JR, et al.Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer:a National Cancer Institute conference[J].J Clin Oncol, 2008, 26(5):791-797.
17.	Classe JM, Bordes V, Campion L, et al.Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer:results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study[J].J Clin Oncol, 2009, 27(5):726-732.
18.	Kilbride KE, Lee MC, Nees AV, et al.Axillary staging prior to neoadjuvant chemotherapy for breast cancer:predictors of recurrence[J].Ann Surg Oncol, 2008, 15(11):3252-3258.
19.	Martin RC 2nd, Chagpar A, Scoggins CR, et al.Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer[J].Ann Surg, 2005, 241(6):1005-1012.
20.	Mamounas EP, Brown A, Anderson S, et al.Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer:results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27[J].J Clin Oncol, 2005, 23(12):2694-2702.
21.	Boughey JC, Suman VJ, Mittendorf EA, et al.Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with nodepositive breast cancer:the ACOSOG Z1071(Alliance) clinical trial[J].JAMA, 2013, 310(14):1455-1461.
22.	Alvarado R, Yi M, Le-Petross H, et al.The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer[J].Ann Surg Oncol, 2012, 19(10):3177-3184.
23.	Kuehn T, Bauerfeind I, Fehm T, et al.Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA):a prospective, multicentre cohort study[J].Lancet Oncol, 2013, 14(7):609-618.
24.	Mamounas EP, Anderson SJ, Dignam JJ, et al.Predictors of locoregional recurrence after neoadjuvant chemotherapy:results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27[J].J Clin Oncol, 2012, 30(32):3960-3966.
25.	Newman EA, Sabel MS, Nees AV, et al.Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation[J].Ann Surg Oncol, 2007, 14(10):2946-2952.
26.	Hunt KK, Yi M, Mittendorf EA, et al.Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients[J].Ann Surg, 2009, 250(4):558-566.

1. Mauri D, Pavlidis N, Ioannidis JP.Neoadjuvant versus adjuvant systemic treatment in breast cancer:a meta-analysis[J].J Natl Cancer Inst, 2005, 97(3):188-194.
2. Mieog JS, van der Hage JA, van de Velde CJ.Neoadjuvant chemotherapy for operable breast cancer[J].Br J Surg, 2007, 94(10):1189-1200.
3. Rastogi P, Anderson SJ, Bear HD, et al.Preoperative chemotherapy:updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27[J].J Clin Oncol, 2008, 26(5):778-785.
4. Chen AM, Meric-Bernstam F, Hunt KK, et al.Breast conservation after neoadjuvant chemotherapy:the MD Anderson Cancer center experience[J].J Clin Oncol, 2004, 22(12):2303-2312.
5. Chen AM, Meric-Bernstam F, Hunt KK, et al.Breast conservation after neoadjuvant chemotherapy[J].Cancer, 2005, 103(4):689-695.
6. Rouzier R, Mathieu MC, Sideris L, et al.Breast-conserving surgery after neoadjuvant anthracycline-based chemotherapy for large breast tumors[J].Cancer, 2004, 101(5):918-925.
7. Ishitobi M, Ohsumi S, Inaji H, et al.Ipsilateral breast tumor recurrence (IBTR) in patients with operable breast cancer who undergo breast-conserving treatment after receiving neoadjuvant chemotherapy:risk factors of IBTR and validation of the MD Anderson Prognostic Index[J].Cancer, 2012, 118(18):4385-4393.
8. Rouzier R, Extra JM, Carton M, et al.Primary chemotherapy for operable breast cancer:incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery[J].J Clin Oncol, 2001, 19(18):3828-3835.
9. Thomas JS, Julian HS, Green RV, et al.Histopathology of breast carcinoma following neoadjuvant systemic therapy:a common association between letrozole therapy and central scarring[J].Histopathology, 2007, 51(2):219-226.
10. Wang S, Zhang Y, Yang X, et al.Shrink pattern of breast cancer after neoadjuvant chemotherapy and its correlation with clinical pathological factors[J].World J Surg Oncol, 2013, 11(1):166.
11. Yang T, Zhang ZP, Liu G, et al.Pathological shrinkage modes of the breast primary tumor after neoadjuvant chemotherapy with part-mount sub-serial section and three-dimensional reconstruction technique[C].3rd International Breast Cancer Symposium.Korea:Korean Breast Cancer Society, 2014:282-283.
12. Bear HD, Anderson S, Brown A, et al.The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide:preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27[J].J Clin Oncol, 2003, 21(22):4165-4174.
13. van Deurzen CH, Vriens BE, Tjan-Heijnen VC, et al.Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients:a systematic review[J].Eur J Cancer, 2009, 45(18):3124-3130.
14. Kelly AM, Dwamena B, Cronin P, et al.Breast cancer sentinel node identification and classification after neoadjuvant chemotherapy-systematic review and meta analysis[J].Acad Radiol, 2009, 16(5):551-563.
15. Kim T, Giuliano AE, Lyman GH.Lymphatic mapping and sent inel lymph node biopsy in early-stage breast carcinoma:a meta analysis[J].Cancer, 2006, 106(1):4-16.
16. Buchholz TA, Lehman CD, Harris JR, et al.Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer:a National Cancer Institute conference[J].J Clin Oncol, 2008, 26(5):791-797.
17. Classe JM, Bordes V, Campion L, et al.Sentinel lymph node biopsy after neoadjuvant chemotherapy for advanced breast cancer:results of Ganglion Sentinelle et Chimiotherapie Neoadjuvante, a French prospective multicentric study[J].J Clin Oncol, 2009, 27(5):726-732.
18. Kilbride KE, Lee MC, Nees AV, et al.Axillary staging prior to neoadjuvant chemotherapy for breast cancer:predictors of recurrence[J].Ann Surg Oncol, 2008, 15(11):3252-3258.
19. Martin RC 2nd, Chagpar A, Scoggins CR, et al.Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer[J].Ann Surg, 2005, 241(6):1005-1012.
20. Mamounas EP, Brown A, Anderson S, et al.Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer:results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27[J].J Clin Oncol, 2005, 23(12):2694-2702.
21. Boughey JC, Suman VJ, Mittendorf EA, et al.Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with nodepositive breast cancer:the ACOSOG Z1071(Alliance) clinical trial[J].JAMA, 2013, 310(14):1455-1461.
22. Alvarado R, Yi M, Le-Petross H, et al.The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer[J].Ann Surg Oncol, 2012, 19(10):3177-3184.
23. Kuehn T, Bauerfeind I, Fehm T, et al.Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA):a prospective, multicentre cohort study[J].Lancet Oncol, 2013, 14(7):609-618.
24. Mamounas EP, Anderson SJ, Dignam JJ, et al.Predictors of locoregional recurrence after neoadjuvant chemotherapy:results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27[J].J Clin Oncol, 2012, 30(32):3960-3966.
25. Newman EA, Sabel MS, Nees AV, et al.Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation[J].Ann Surg Oncol, 2007, 14(10):2946-2952.
26. Hunt KK, Yi M, Mittendorf EA, et al.Sentinel lymph node surgery after neoadjuvant chemotherapy is accurate and reduces the need for axillary dissection in breast cancer patients[J].Ann Surg, 2009, 250(4):558-566.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress of Locoregional Surgery for Breast Cancer Patients after Neoadjuvant Chemotherapy

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