Follow-up Surgery Not Needed When Breast Cancer Responds to Neoadjuvant Chemotherapy

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Researchers report that some women with initial node-negative disease may be able to avoid breast and axillary surgery.
Researchers report that some women with initial node-negative disease may be able to avoid breast and axillary surgery.

Select patients with breast cancer who achieve pathologic complete response after chemotherapy may be able to avoid follow-up breast and lymph node surgery, according to findings from researchers at The University of Texas MD Anderson Cancer Center. In the study, published in JAMA Surgery, the researchers identify exceptional responders who are at the lowest risk for local metastases and thereby candidates for less invasive treatment options.

The prospective single-institution cohort study enrolled 527 women with T1-T2/N0-N1 triple-negative (n = 264) or HER2 positive (n = 263) breast cancer treated between January 2010 and December 2014.  All the participants received neoadjuvant chemotherapy followed by standard breast and nodal surgery. Clinical staging was determined prior to neoadjuvant chemotherapy by core biopsy or fine-needle aspiration, followed by clinical examination, mammography, and ultrasound of the breast and axilla.

Overall, 36.6% of patients achieved a complete response, with a slightly higher rate among those with triple-negative (37.5%) vs HER2 positive (35.7%) breast cancer. Of patients presenting with N1 disease, 77 (32.5%) achieved a complete response compared with 116 of those with N0 disease (40%).

Based on these findings, the researchers report that some women with initial node-negative disease may be able to avoid breast and axillary surgery if they achieve a complete response after neoadjuvant chemotherapy. 

Reference

1. Tadros AB, Yang WT, Krishnamurthy S, et al.  Identification of patients with documented pathologic complete response in the breast after neoadjuvant chemotherapy for omission of axillary surgery [published online April 19, 2017]. JAMA Surg. doi:10.1001/jamasurg.2017.0562

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