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Ipsilateral breast tumor recurrence and local-regional recurrence after neoadjuvant chemotherapy and breast-conserving therapy
The most clearly established advantage of neoadjuvant chemotherapy (NACT) is its ability to convert patients initially ineligible for breast conservation therapy (BCT) into candidates for this treatment strategy. Using selective but traditional criteria for BCT, our observed ipsilateral breast tumor recurrence (IBTR) is very low and compares favorably with early stage breast cancer patients undergoing BCT without NACT. We believe that the key to successful BCT after NACT is careful patient selection and coordination among treatment specialists. Patients with positive margins should undergo re-excision if technically feasible. The same criteria used for the selection of candidates for breast conservation are appropriate in patients after NACT as for patients with early breast tumors treated by breast conservation without initial NACT. These are, namely, the absence of multicentric disease, the absence of widespread malignant-appearing calcifications, and the ability to excise the residual tumor completely with clear margins and a suitable cosmetic result. In conclusion, the findings of this study demonstrate that BCT is accompanied by low rates of IBTR and local-regional recurrence (LRR) in appropriately selected patients. Advanced stage at presentation is associated with increased risk of IBTR although the overall recurrence is low. Employed selectively, BCT is a safe and effective alternative to mastectomy after NACT.
Bibliogrtaphical reference:
Sushil Beriwal Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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