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Scardina L, Carnassale B, Di Leone A, Sanchez AM, Biondi E, Moschella F, D'Archi S, Franco A, De Lauretis F, Di Guglielmo E, Petrazzuolo E, Magno S, Masetti R, Franceschini G. Young Women with Early-Stage Breast Cancer Treated with Upfront Surgery: Overview of Oncological Outcomes. J Clin Med 2024; 13:3966. [PMID: 38999531 PMCID: PMC11242681 DOI: 10.3390/jcm13133966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/21/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Breast cancer in young women aged < 40 years is rare and often aggressive with less favorable survival rates. The lack of systematic screening, later stage at diagnosis, and a more aggressive disease biology may all contribute to their poor prognosis. Data on the best management remain conflicting, especially those regarding surgical management, either breast-conserving or mastectomy. To our knowledge, there are limited studies surrounding the treatment of young women with early breast cancer, and this analysis evaluated the oncological outcomes for those patients who underwent surgery upfront. Methods: We conducted a retrospective study including 130 young women with early breast cancer from a total of 373 consecutive patients treated with upfront surgery between January 2016 and December 2021 at our institution. Local recurrence-free survival (LR-FS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were evaluated. Results: The median follow-up was 61.1 months (range, 25-95). A total of 92 (70.8%) patients underwent breast-conserving surgery, while 38 (29.2%) patients underwent conservative mastectomy with immediate implant breast reconstruction. In total, 8 of 130 patients (6.2%) developed a local recurrence in the treated breast, an7 (5.4%) patients presented distant metastasis. Overall, two (1.6%) patients died due to breast cancer recurrence. Conclusions: The results of our study interestingly support breast-conserving surgery in young patients with early-stage breast cancer. While appropriate breast-conserving surgery can achieve favorable oncological outcomes and can always be considered a valid alternative to conservative mastectomy in upfront surgery, a younger age at diagnosis should never be used alone to choose the type of surgery.
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Affiliation(s)
- Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Beatrice Carnassale
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alejandro Martin Sanchez
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Ersilia Biondi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Moschella
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sabatino D'Archi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Flavia De Lauretis
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Guglielmo
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Eleonora Petrazzuolo
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Magno
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Zeng CY, Qiu YY, Li JY, Huang JH, Bai XS, Han XL, He XD. Locally advanced breast cancer patients should be cautious about the immediate breast reconstruction after mastectomy: a pooling analysis of safety and efficacy. World J Surg Oncol 2024; 22:165. [PMID: 38918808 PMCID: PMC11197261 DOI: 10.1186/s12957-024-03444-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The purpose of this study was to compare safety and efficacy outcomes between immediate breast reconstruction (IBR) and mastectomy alone in locally advanced breast cancer patients. METHODS We conducted a comprehensive literature search of PUBMED, EMBASE, and Cochrane databases. The primary outcomes evaluated were overall survival, disease-free survival, and local recurrence. The secondary outcome was the incidence of surgical complications. All data were analyzed using Review Manager 5.3. RESULTS Sixteen studies, involving 15,364 participants were included in this meta-analysis. Pooled data demonstrated that patients underwent IBR were more likely to experience surgical complications than those underwent mastectomy alone (HR: 3.96, 95%CI [1.07,14.67], p = 0.04). No significant difference was found in overall survival (HR: 0.94, 95%CI [0.73,1.20], p = 0.62), disease-free survival (HR: 1.03, 95%CI [0.83,1.27], p = 0.81), or breast cancer specific survival (HR: 0.93, 95%CI [0.71,1.21], p = 0.57) between IBR group and Non-IBR group. CONCLUSIONS Our study demonstrates that IBR after mastectomy does not affect the overall survival and disease-free survival of locally advanced breast cancer patients. However, IBR brings with it a nonnegligible higher risk of complications and needs to be fully evaluated and carefully decided.
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Affiliation(s)
- Cheng-Yu Zeng
- Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Yan-Yu Qiu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District,, Beijing, China
| | - Jia-Yi Li
- Eight-Year Program of Clinical Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Jian-Hao Huang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District,, Beijing, China
| | - Xue-Song Bai
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District,, Beijing, China
| | - Xian-Lin Han
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District,, Beijing, China.
| | - Xiao-Dong He
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District,, Beijing, China.
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3
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Hashem M, Rehman S, Salhab M. The Role of Human Epidermal Growth Factor Receptor 2 (HER2)-Targeted Therapies in Early-Stage Breast Cancer: Current Practices, Treatment De-escalation, and Future Prospects. Cureus 2024; 16:e55230. [PMID: 38558735 PMCID: PMC10981386 DOI: 10.7759/cureus.55230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-targeted therapy has transformed the treatment paradigm for early-stage HER2-positive breast cancer, providing personalized and effective interventions. This comprehensive review delves into the current state of HER2-targeted therapies, emphasizing pivotal clinical trials that have demonstrated their substantial impact on long-term outcomes. Combination therapies that integrate HER2-targeted agents with chemotherapy exhibit enhanced tumor responses, particularly in neoadjuvant settings. Neoadjuvant chemotherapy (NACT) is explored for its role in tumor downsizing, facilitating breast-conserving surgery (BCS), and incorporating oncoplastic solutions to address both oncologic efficacy and aesthetic outcomes. Innovative axillary management post-NACT, such as targeted axillary dissection (TAD), is discussed for minimizing morbidity. The review further explores the delicate balance between maximal therapy and de-escalation, reflecting recent trends in treatment approaches. The therapeutic landscape of HER2-low breast cancer is examined, highlighting considerations in HER2-positive breast cancer with BReast CAncer gene (BRCA) mutations. Emerging immunotherapeutic strategies, encompassing immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cell therapy, are discussed in the context of their potential integration into treatment paradigms. In conclusion, the evolving landscape of HER2-positive early-stage breast cancer treatment, characterized by targeted therapies and multidisciplinary approaches, underscores the need for ongoing research and collaborative efforts. The aim is to refine treatment strategies and enhance patient outcomes in this dynamic and rapidly evolving field.
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Affiliation(s)
- Mohamed Hashem
- Breast Surgery, Mid Yorkshire NHS Teaching Trust, Wakefield, GBR
| | - Shazza Rehman
- Oncology, Airedale NHS Foundation Trust, Airedale, GBR
| | - Mohamed Salhab
- Breast Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, GBR
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4
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Turgeon MK, Willcox LM, Styblo TM, Losken A. Impact of Oncoplastic Surgery on Oncologic Outcomes in Patients with Breast Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5561. [PMID: 38292812 PMCID: PMC10827286 DOI: 10.1097/gox.0000000000005561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
Background For patients with breast cancer, oncoplastic surgery (OPS) serves as a valuable technique that allows for immediate reconstruction at the time of resection. While the aim of OPS is to improve breast cosmesis, it is critical to ensure OPS does not negatively impact appropriate cancer treatment. Methods Based on current literature, this study provides a broad overview on the potential oncologic advantages of OPS for patients diagnosed with breast cancer. Results OPS has been shown to be a safe and reliable approach with oncologic advantages. More specifically, OPS broadens the indications for breast conservation therapy (BCT); allows for a more generous margin of resection, thus decreasing rates of re-excision; and provides the opportunity to sample additional breast tissue, which may detect occult disease. Reduction mammaplasty may also decrease the risk for developing breast cancer. Importantly, in the era of multimodality therapy, long-term oncologic outcomes and postoperative surveillance algorithms appear to be similar when comparing patients who undergo OPS and BCT. Conclusions For patients with breast cancer, oncoplastic surgery has emerged as a valuable technique to improve breast cosmesis while achieving optimal oncologic outcomes. As the landscape of breast oncology continues to evolve, it is critical for a multidisciplinary team to be involved to guide management and reconstructive strategies.
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Affiliation(s)
| | | | - Toncred M. Styblo
- Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Ga
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University, Atlanta, Ga
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Franco A, Di Leone A, Conti M, Fabi A, Carbognin L, Terribile AD, Belli P, Orlandi A, Sanchez MA, Moschella F, Mason EJ, Cimino G, De Filippis A, Marazzi F, Paris I, Visconti G, Barone Adesi L, Scardina L, D’Archi S, Salgarello M, Giannarelli D, Masetti R, Franceschini G. An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy. J Pers Med 2023; 13:1280. [PMID: 37623530 PMCID: PMC10455579 DOI: 10.3390/jpm13081280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/05/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons' expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes. METHODS Patients (stage I-III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included. Data selected were BRCA mutation, ptosis, breast volume, radiological response, MRI, and mammography pre- and post-NACT prediction of excised breast area. pNESSy was created using the association between these data and surgery. Area under the curve (AUC) was assessed. Patients were divided into groups according to correspondence (G1) or discrepancy (G2) between score and surgery; oncological and aesthetic outcomes were analyzed. RESULTS A total of 255 patients were included (118 BCS, 49 OPS, 88 CMR). pNESSy between 6.896-8.724 was predictive for BCS, 8.725-9.375 for OPS, and 9.376-14.245 for CMR; AUC was, respectively, 0.835, 0.766, and 0.825. G1 presented a lower incidence of involved margins (5-14.7%; p = 0.010), a better locoregional disease-free survival (98.8-88.9%; p < 0.001) and a better overall survival (96.1-86.5%; p = 0.017), and a better satisfaction with breasts (39.8-27.5%; p = 0.017) and physical wellbeing (93.5-73.6%; p = 0.001). CONCLUSION A score system based on clinical and radiological features was created to select the optimal surgery post-NACT and improve oncological and aesthetic outcomes.
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Affiliation(s)
- Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Marco Conti
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Luisa Carbognin
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Andreina Daniela Terribile
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Paolo Belli
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Armando Orlandi
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Martin Alejandro Sanchez
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Francesca Moschella
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Elena Jane Mason
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Giovanni Cimino
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Alessandra De Filippis
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Fabio Marazzi
- Cancer Radiation Therapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Ida Paris
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Giuseppe Visconti
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Liliana Barone Adesi
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Sabatino D’Archi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Marzia Salgarello
- Plastic Surgery, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (A.F.)
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Khoury T. The Evolving Approach to Breast Cancer: Moving toward De-Escalating Treatment and Personalized Medicine. Cancers (Basel) 2023; 15:3502. [PMID: 37444611 DOI: 10.3390/cancers15133502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
In recent years, more attention has been directed to personalized medicine in the management and treatment of breast cancer (BC) [...].
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA
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7
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Di Leone A, Franco A, Zotta F, Scardina L, Sicignano M, Di Guglielmo E, Castagnetta V, Magno S, Terribile D, Sanchez AM, Franceschini G, Masetti R. Local Treatment of Triple-Negative Breast Cancer: Is Mastectomy Superior to Breast-Conserving Surgery? J Pers Med 2023; 13:jpm13050865. [PMID: 37241035 DOI: 10.3390/jpm13050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). TNBC accounts for about 15% of breast cancers and has a poorer prognosis as compared with other subtypes of breast cancer. The more rapid onset of this cancer and its aggressiveness have often convinced breast surgeons that mastectomy could provide better oncological results. However, there is no relevant clinical trial that has assessed differences between breast-conserving surgery (BCS) and mastectomy (M) in these patients. This population-based study aimed to investigate the distinct outcomes between conservative treatment and M in a case series of 289 patients with TNBC treated over a 9-year period. This monocentric study retrospectively evaluated patients with TNBC who underwent upfront surgery at Fondazione Policlinico Agostino Gemelli IRCCS, in Rome, between 1 January 2013 and 31 December 2021. First, the patients were divided in two groups according to the surgical treatment received: BCS vs. M. Then, the patients were stratified into four risk subclasses based on combined T and N pathological staging (T1N0, T1N+, T2-4N0 and T2-4N+). The primary endpoint of the study was to evaluate locoregional disease-free survival (LR-DFS), distant disease-free survival (DDFS) and overall survival (OS) in the different subclasses. We analyzed 289 patients that underwent either breast-conserving surgery (247/289, 85.5%) or mastectomy (42/289, 14.5%). After a median follow-up of 43.2 months (49.7, 22.2-74.3), 28 patients (9.6%) developed a locoregional recurrence, 27 patients (9.0%) showed systemic recurrence and 19 patients (6.5%) died. No significant differences due to type of surgical treatment were observed in the different risk subclasses in terms of locoregional disease-free survival, distant disease-free survival and overall survival. With the limits of a retrospective, single-center study, our data seem to indicate similar efficacy in terms of locoregional control, distant metastasis and overall survival with the use of upfront breast-conserving surgery as compared with radical surgery in the treatment of TNBC. Therefore, TNBC should not be considered to be a contraindication for breast conservation.
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Affiliation(s)
- Alba Di Leone
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Franco
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Zotta
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Scardina
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Margherita Sicignano
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Guglielmo
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Virginia Castagnetta
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Magno
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Terribile
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alejandro Martin Sanchez
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Masetti
- Multidisciplinary Breast Center, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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8
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Franco A, Di Leone A, Fabi A, Belli P, Carbognin L, Gambaro E, Marazzi F, Mason EJ, Mulè A, Orlandi A, Palazzo A, Paris I, Rossi A, Scardina L, Terribile DA, Tiberi G, Giannarelli D, Scambia G, Masetti R, Franceschini G. Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting. Cancers (Basel) 2023; 15:cancers15092450. [PMID: 37173916 PMCID: PMC10177504 DOI: 10.3390/cancers15092450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The diffusion of screening programs has resulted in a decrease of cT4 breast cancer diagnosis. The standard care for cT4 was neoadjuvant chemotherapy (NA), surgery, and locoregional or adjuvant systemic therapies. NA allows two outcomes: 1. improve survival rates, and 2. de-escalation of surgery. This de-escalation has allowed the introduction of conservative breast surgery (CBS). We evaluate the possibility of submitting cT4 patients to CBS instead of radical breast surgery (RBS) by assessing the risk of locoregional disease-free survival, (LR-DFS) distant disease-free survival (DDFS), and overall survival (OS). METHODS This monocentric, retrospective study evaluated cT4 patients submitted to NA and surgery between January 2014 and July 2021. The study population included patients undergoing CBS or RBS without immediate reconstruction. Survival curves were obtained using the Kaplan-Meyer method and compared using a Log Rank test. RESULTS At a follow-up of 43.7 months, LR-DFS was 70% and 75.9%, respectively, in CBS and RBS (p = 0.420). DDFS was 67.8% and 29.7%, respectively, (p = 0.122). OS was 69.8% and 59.8%, respectively, (p = 0.311). CONCLUSIONS In patients with major or complete response to NA, CBS can be considered a safe alternative to RBS in the treatment of cT4a-d stage. In patients with poor response to NA, RBS remained the best surgical choice.
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Affiliation(s)
- Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alessandra Fabi
- Precision Medicine Senology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Paolo Belli
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Luisa Carbognin
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Elisabetta Gambaro
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Fabio Marazzi
- Cancer Radiation Therapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Elena Jane Mason
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Antonino Mulè
- Anatomic Pathology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Armando Orlandi
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Antonella Palazzo
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Ida Paris
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alessandro Rossi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", 00135 Roma, Italy
| | - Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Daniela Andreina Terribile
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Giordana Tiberi
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Giovanni Scambia
- Gynecological Oncology Unit, Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
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