Impact of oncoplasty in increasing breast conservation rates Post neo-adjuvant chemotherapy

Frontiers in Oncology

Oncology

Pooja Vaid¹  Nutan Jumle²  Upendra Dhar³  Beenu Varghese³  Chetan Deshmukh³  Sunil Badve⁴  Vaishali Zamre⁵  Jerome Pereira⁶  George Thomas⁷  Laleh Busheri⁸  Devaki A. Kelkar⁹  Nutan Gangurde⁹  Rohini Unde⁹  Namrata Namewar⁹  Anjali Joshi⁹  Smeeta Nare⁹  Mugdha Pai⁹  Rituja Banale⁹  Shweta Kadu⁹  Madhura Kulkarni⁹  Chaitanyanand B. Koppiker^1,10 

[1] Center for Translational Cancer Research, a Joint venture between Prashanti Cancer Care Mission and Indian Institute of Science Education and Research (IISER), Pune, India;Ashoka University – Department of Biology, Ashoka University, Haryana, India;Department of Onco-Sciences, Jehangir Hospital, Pune, India;Department of Onco-Sciences, Jehangir Hospital, Pune, India;Orchids Breast Health Centre, A Prashanti Cancer Care Mission (PCCM) Initiative, Pune, India;Department of Pharmacology and Chemical Biology, Emory University, Atlanta, GA, United States;International School of Oncoplasty, Pune, India;Norwich Medical School, University of East Anglia, Norwich, United Kingdom;Orchids Breast Health Centre, A Prashanti Cancer Care Mission (PCCM) Initiative, Pune, India;Prashanti Cancer Care Mission, Pune, India;Prashanti Cancer Care Mission, Pune, India;Center for Translational Cancer Research, a Joint venture between Prashanti Cancer Care Mission and Indian Institute of Science Education and Research (IISER), Pune, India;Prashanti Cancer Care Mission, Pune, India;Center for Translational Cancer Research, a Joint venture between Prashanti Cancer Care Mission and Indian Institute of Science Education and Research (IISER), Pune, India;Department of Onco-Sciences, Jehangir Hospital, Pune, India;International School of Oncoplasty, Pune, India;Orchids Breast Health Centre, A Prashanti Cancer Care Mission (PCCM) Initiative, Pune, India;

关键词: neoadjuvant chemotherapy;    breast cancer;    breast conservation for large tumors;    mastectomy;    oncoplastic breast conservation;    frozen section analysis;    tumor localization;   

DOI  :  10.3389/fonc.2023.1176609

 received in 2023-02-28, accepted in 2023-07-19,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThe essential goal of neoadjuvant chemotherapy (NACT) is to downstage the primary tumor making it amenable for breast conservation surgery (BCS). However, since the safety of this surgery is paramount, post-NACT breast conservation rates remain low. As per the recommendation of the 2018 Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) overview of long-term post-NACT follow-up, we have devised a protocol for imaging, localization, rad-path analysis, and documentation of radiotherapy techniques to ensure the safety of post-NACT breast conservation.MethodsThis is a retrospective cohort of 180 breast cancer patients who received NACT and were operated on by a single surgical oncologist from 2015 to 2020. After selection based on published guidelines, patients were treated with neoadjuvant systemic (chemo or hormone) therapy. In cases where primary tumors responded and reduced to 1–2 cm in size mid-NACT, the residual tumors were localized by clips under ultrasound guidance and calcification was wire localized. All patients were treated using appropriate surgical and oncoplastic techniques where indicated. Negative margins were ensured by intra-operative rad-path analysis. Adjuvant chemotherapy and radiotherapy were given as per protocol.ResultsIn 81 cases that required mastectomy at presentation, we were able to achieve a 72.8% post-NACT BCS rate with the help of oncoplasty. Overall, 142 of 180 (80%) patients were treated with breast conserving surgery of which 80% (121 of 142) were oncoplasty. Margins were assessed on intra-operative frozen and re-excised in the same setting. No positive margins were reported in final histopath of 142 breast conservation procedures. Post-operative complication rates after breast conservation in the first year were at 17% (24 of 142 including two major complications). Patient reported outcomes were satisfactory with increased satisfaction for breast conservation compared with immediate breast reconstruction.DiscussionEmploying oncoplastic breast surgery (OBS) techniques following stringent protocols for accurate localization of the residual tumor, intra-operative rad-path analysis, and adjuvant treatments, we show successful breast conservation in 72.8% of our mastectomy-qualified patients after downstaging by NACT. We also report satisfactory outcomes for post-NACT surgery, patient-reported satisfaction, and survival.

【 授权许可】

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Copyright © 2023 Koppiker, Kelkar, Kulkarni, Kadu, Pai, Dhar, Deshmukh, Varghese, Zamre, Jumle, Gangurde, Joshi, Unde, Banale, Namewar, Vaid, Busheri, Thomas, Nare, Pereira and Badve