title: Is breast preservation possible in women with large, locally advanced breast cancers?
abstract: Breast conservation therapy is an accepted treatment option for early stage breast carcinoma, but is rarely considered appropriate for locally advanced nonmetastatic lesions. Mastectomy specimens of 46/50 patients treated at the Ochsner Clinic and the Mallinckrodt Institute of Radiology with neoadjuvant chemotherapy prior to mastectomy +/- irradiation were evaluated by a single pathologist to assess tumor response to chemotherapy. Forty percent of this group would potentially have been eligible for breast conservation therapy, using a residual tumor size of < or = 4 cm with negative surgical margins as the criteria. Patients most likely to qualify for breast conservation therapy were those with T3N0-1 lesions (67%). Least likely were patients with skin involvement at diagnosis 4/33 (12%). Tumors with an extensive intraductal component at biopsy often had residual islands of intraductal carcinoma occupying the original tumor volume, even when the invasive component was absent or much reduced. A prospective trial will be required to determine whether or not acceptable local control rates can be obtained after breast conservation therapy for that subset of patients with a favorable response to induction chemotherapy.
authors: Ochsner Center for Radiation Oncology, New Orleans.
authors: R R
authors: RR
authors: Kuske
authors: G H
authors: GH
authors: Farr
authors: K
authors: K
authors: Harris
authors: J S
authors: JS
authors: Bolton
authors: A
authors: A
authors: Sardi
authors: W H
authors: WH
authors: McKinnon
authors: C G
authors: CG
authors: Kardinal
authors: J
authors: J
authors: Cole
authors: T K
authors: TK
authors: Pickett
authors: M L
authors: ML
authors: Graham
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012074:Remission Induction