Recurrence rates after DCE-MRI image guided planning for breast-conserving surgery following neoadjuvant chemotherapy for locally advanced breast cancer patients
| Autor: | Lindsay W. Turnbull, John N. Fox, Ervine D. Long, V. Garimella, A. Chaturvedi, O. Qutob, Philip J. Drew |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Breast Neoplasms Preoperative care Breast cancer Median follow-up Antineoplastic Combined Chemotherapy Protocols Preoperative Care medicine Breast-conserving surgery Humans Cyclophosphamide Lymph node Mastectomy Neoadjuvant therapy Aged Retrospective Studies business.industry Incidence General Medicine Middle Aged medicine.disease Magnetic Resonance Imaging Neoadjuvant Therapy Surgery Methotrexate Treatment Outcome medicine.anatomical_structure England Oncology Chemotherapy Adjuvant Female Fluorouracil Neoplasm Recurrence Local business Immunosuppressive Agents Progressive disease Follow-Up Studies |
| Zdroj: | European Journal of Surgical Oncology (EJSO). 33:157-161 |
| ISSN: | 0748-7983 |
| Popis: | Background Neoadjuvant therapy results in a significant increase in breast-conserving surgery. However, traditional imaging methods are unable to accurately predict the extent of viable residual disease leading to uncertainty in surgical planning and some previous studies have shown a disproportionately high incidence of locoregional recurrence. Dynamic contrast enhanced-MRI (DCE-MRI) has been shown to provide a potentially more accurate prediction of residual disease. Results Patients undergoing neoadjuvant chemotherapy for breast cancer in our unit are staged with the DCE-MRI of the breast performed at 1.5 T before, during and after treatment and the final result was used to plan surgery. Two hundred and four patients with breast cancer were treated with neoadjuvant chemotherapy between 1996 and April 2005. Eighteen of these patients had distant metastases at the time of initial diagnosis and so were excluded from the present study. Following neoadjuvant chemotherapy, 186 patients underwent surgical treatment. Of these, 68 patients had breast-conserving surgery. At a median follow up of 30 months (range: 5.6–72 months) 21 patients in this group developed subsequent recurrence (21/68 – 30%) of whom 9 (9/68 – 13%) had locoregional recurrence, 7 had local recurrence (7/68 – 10%), and 17 (17/68 – 25%) had distant recurrence. Logistic regression analysis revealed only vascular invasion (p = 0.006) of the tumour to be significantly associated with overall recurrence. None of the pathological factors (ER, PR status, vascular invasion, lymph node metastases, pathological complete response to neoadjuvant chemotherapy) showed a significant association with locoregional recurrence. Conclusion Breast-conserving surgery with DCE-MRI planning after neoadjuvant chemotherapy provides an acceptable level of local recurrence without the need for mastectomy. |
| Databáze: | OpenAIRE |
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