Recurrence of Breast Cancer No Less If Chemo First

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Recurrence of Breast Cancer No Less If Chemo First

Posted On : Oct-21-2011 | seen (195) times | Article Word Count : 538 |

Timing of chemotherapy may not be as important as tumor characteristics in outcomes after lumpectomy for breast cancer, researchers found.

Timing of chemotherapy may not be as important as tumor characteristics in outcomes after lumpectomy for breast cancer, researchers found.

Neoadjuvant chemotherapy had no impact on locoregional recurrence compared with a strategy of surgery first in an analysis stratifying for the number of adverse factors present, Elizabeth A. Mittendorf, MD, of the MD Anderson Cancer Center in Houston, and colleagues found.

Nor was timing of chemotherapy a significant factor in the multivariate analysis, whereas tumor characteristics were, the group reported here at the Multidisciplinary Breast Cancer Symposium.

"The biology is really driving this more than the specific locoregional treatment that you choose," Mittendorf told MedPage Today.

The study included 2,984 women who underwent breast-conserving therapy at MD Anderson from 1987 through 2005.

Of the 22% who underwent neoadjuvant chemotherapy rather than surgery first, nearly all with clinical stage II/III disease (93%) saw a downstaging of their tumor, including pathologic complete response in 20%.

Patients who had chemotherapy first had somewhat poorer locoregional recurrence-free survival than those who had surgery first out to 10 years (90% versus 94%, P<0.001).
Their distant metastasis-free survival and disease-specific survival rates were also worse compared with surgery first (both P<0.001).

However, the neoadjuvant group had a poorer baseline risk profile with:
• Younger age
• Greater likelihood of presenting with clinical stage II or III disease
• Nuclear grade 3
• Estrogen receptor-negative disease

The multivariate analysis identified all these factors as well as multifocal disease, close or positive margins, lymphovascular invasion, and estrogen receptor-positive disease not treated with hormonal therapy as significant for locoregional recurrence-free survival.
Stratifying for these factors, each level of risk showed similar locoregional recurrence-free survival rates:
• Zero risk factors (P=0.432)
• One risk factor (P=0.889)
• Two risk factors (P=0.216)
• Three risk factors (P=0.804)
• Four risk factors (P=0.262)

"Appropriately selected patients achieve high rates of locoregional control with breast conserving therapy," the researchers concluded.

Study discussant Barbara Fowble, MD, of the University of California San Francisco, questioned whether women with three or four risk factors should be getting breast-conserving surgery at all.

In women with three to four risk factors, ten-year locoregional failure rate jumped to 61% with breast-conserving therapy versus just 19% with mastectomy and radiation in a prior study, Fowble noted.

She urged identification of women whose locoregional failure risk would be lower with mastectomy, personalizing the decision based on factors such as initial tumor stage and molecular subtype.

However, the higher locoregional recurrence risk doesn't necessarily translate into an effect on overall survival, Mittendorf countered.

"The reason we can't say that is because in our patient population, there are too few events to be able to draw that conclusion," she pointed out in an interview. "It's a conversation you have to have with your patient."

Surgeons have sometimes been reluctant to do breast-conserving surgery after neoadjuvant chemotherapy because of the difficulty of knowing the extent of disease and what needs to be resected after chemotherapy, Mittendorf noted.

"This is the largest, hopefully soon to be published, series of breast-conserving surgery after neoadjuvant chemotherapy," she told MedPage Today. "Hopefully it will give surgeons the data to be more comfortable doing breast-conserving surgery in these patients."

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<h1>Recurrence of Breast Cancer No Less If Chemo First</h1> Author: <a href='http://www.articleseen.com/profile_choicecancercare.aspx'>choicecancercare</a> Timing of chemotherapy may not be as important as tumor characteristics in outcomes after lumpectomy for breast cancer, researchers found.

Neoadjuvant chemotherapy had no impact on locoregional recurrence compared with a strategy of surgery first in an analysis stratifying for the number of adverse factors present, Elizabeth A. Mittendorf, MD, of the MD Anderson Cancer Center in Houston, and colleagues found.

Nor was timing of chemotherapy a significant factor in the multivariate analysis, whereas tumor characteristics were, the group reported here at the Multidisciplinary Breast Cancer Symposium.

"The biology is really driving this more than the specific locoregional treatment that you choose," Mittendorf told MedPage Today.

The study included 2,984 women who underwent breast-conserving therapy at MD Anderson from 1987 through 2005.

Of the 22% who underwent neoadjuvant chemotherapy rather than surgery first, nearly all with clinical stage II/III disease (93%) saw a downstaging of their tumor, including pathologic complete response in 20%.

Patients who had chemotherapy first had somewhat poorer locoregional recurrence-free survival than those who had surgery first out to 10 years (90% versus 94%, P<0.001).
Their distant metastasis-free survival and disease-specific survival rates were also worse compared with surgery first (both P<0.001).

However, the neoadjuvant group had a poorer baseline risk profile with:
•	Younger age
•	Greater likelihood of presenting with clinical stage II or III disease
•	Nuclear grade 3
•	Estrogen receptor-negative disease

The multivariate analysis identified all these factors as well as multifocal disease, close or positive margins, lymphovascular invasion, and estrogen receptor-positive disease not treated with hormonal therapy as significant for locoregional recurrence-free survival.
Stratifying for these factors, each level of risk showed similar locoregional recurrence-free survival rates:
•	Zero risk factors (P=0.432)
•	One risk factor (P=0.889)
•	Two risk factors (P=0.216)
•	Three risk factors (P=0.804)
•	Four risk factors (P=0.262)

"Appropriately selected patients achieve high rates of locoregional control with breast conserving therapy," the researchers concluded.

Study discussant Barbara Fowble, MD, of the University of California San Francisco, questioned whether women with three or four risk factors should be getting breast-conserving surgery at all.

In women with three to four risk factors, ten-year locoregional failure rate jumped to 61% with breast-conserving therapy versus just 19% with mastectomy and radiation in a prior study, Fowble noted.

She urged identification of women whose locoregional failure risk would be lower with mastectomy, personalizing the decision based on factors such as initial tumor stage and molecular subtype.

However, the higher locoregional recurrence risk doesn't necessarily translate into an effect on overall survival, Mittendorf countered.

"The reason we can't say that is because in our patient population, there are too few events to be able to draw that conclusion," she pointed out in an interview. "It's a conversation you have to have with your patient."

Surgeons have sometimes been reluctant to do breast-conserving surgery after neoadjuvant chemotherapy because of the difficulty of knowing the extent of disease and what needs to be resected after chemotherapy, Mittendorf noted.

"This is the largest, hopefully soon to be published, series of breast-conserving surgery after neoadjuvant chemotherapy," she told MedPage Today. "Hopefully it will give surgeons the data to be more comfortable doing breast-conserving surgery in these patients."
About the Author: Choice Cancer Care is an independent physician owned community-based oncology practice in the greater North Texas area that is focused on developing personalized <a rel="nofollow" href=http://www.choicecancercare.com/>cancer treatment</a> plans for patients with cancer and blood disorders. Their dedicated staff of trained and experienced teams Doctors, radiation technologists and oncology specialists, located throughout the Dallas and Ft Worth metroplex, offers the most advanced cancer Article Source: <a href='http://www.articleseen.com/Article_Recurrence-of-Breast-Cancer-No-Less-If-Chemo-First_95054.aspx'> http://www.articleseen.com/Article_Recurrence of Breast Cancer No Less If Chemo First_95054.aspx</a>

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Choice Cancer Care is an independent physician owned community-based oncology practice in the greater North Texas area that is focused on developing personalized cancer treatment plans for patients with cancer and blood disorders. Their dedicated staff of trained and experienced teams Doctors, radiation technologists and oncology specialists, located throughout the Dallas and Ft Worth metroplex, offers the most advanced cancer

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