Breast conserving therapy offers good outcome if criteria are met

December 03, 2003

SAN ANTONIO -- The largest single-institution study of its kind has found that breast conserving therapy after neoadjuvant chemotherapy offers a good outcome as long as patients meet a certain profile, say researchers from The University of Texas M. D. Anderson Cancer Center.

The results, presented at the San Antonio Breast Cancer Symposium, should help establish acceptable guidelines for use of the treatment, which is still considered controversial, says the study's lead author, Thomas Buchholz, M.D., associate professor of radiation oncology at M. D. Anderson.

Use of chemotherapy to shrink a breast tumor before surgery can allow a patient to avoid mastectomy, but concerns have been raised as to whether this treatment increases the likelihood that cancer will recur in the treated breast.

"While this approach is frequently used, a number of surgeons and radiation oncologists still have concerns that treating with breast conservation after neoadjuvant chemotherapy may lead to poorer outcomes than the historical approach in which surgery is used as the first treatment," says Buchholz.

"This study is important because it demonstrated that with proper patient selection, the local recurrence rates for patients treated with breast conservation after neoadjuvant chemotherapy are low," he says. "In addition, because of the sample size of the study, we were able to identify various factors that contribute to its success."

Results from the 362-patient study, which began collecting data in 1987, show that women treated with conservation surgery had low rates of recurrence in the breast, even in those patients with advanced primary tumors. After 5 years, the breast recurrence rate was only 6 percent and the local-regional recurrence rate only 9 percent.

The authors identified the following four factors correlated with the risk of local-regional recurrence:Because some of these same features unfortunately also predict for local-regional recurrence and distant metastases after mastectomy, the authors say they do not consider any one of these features to be a contraindication to a breast conserving approach.

"We have now demonstrated that breast conservation therapy after neoadjuvant chemotherapy is a safe and effective alternative to mastectomy for many patients," Buchholz says. "The key to successful use of the treatment lies in careful patient selection and coordination among treatment specialists."

University of Texas M. D. Anderson Cancer Center

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