[Neoadjuvant chemotherapy of breast cancer. Role of surgery in cases of complete clinical response].
OBJECTIVE
Assess the importance of systematic surgical exploration of the tumor focus in case of complete clinical response to neoadjuvant chemotherapy for operable breast cancer.


METHODS
Between 1985 and 1997, first intention chemotherapy (4 to 6 cures) was given to 433 breast cancer patients with resectable tumors measuring > or = 3 cm but who required mammectomy. Complete clinical response was observed in 112 patients (26%); 31 of them had normal mammography and ultrasound examinations (7%). Local treatment in this favorable context varied: 82 patients underwent surgery (71 conservative procedures, 11 radical procedures) and 30 patients received radiation therapy alone.


RESULTS
Complete histological response was obtained in 22 cases accounting for 6% of the entire series, 27% of the complete clinical responses, and 45% of the complete clinical and imaging responses. The incidence of local recurrence at a mean 107 month follow-up was compared between patients given complementary surgical or radiation therapy after complete clinical response. Recurrence was observed in 10 of the 82 operated patients versus 8 of the 30 nonoperated patients (12% versus 27%, NS).


CONCLUSIONS
Complete clinical response after neoadjuvant chemotherapy does not rule out the need for surgical resection of the tumor focus because the risk of neoplastic reliquats remains high (3 out of 4 cases) and because the surgical specimen provides important histological information for prognosis (in vivo chemosensitivity test). lumpectomy also contributes to reducing the risk of local recurrence.
Le Bouëdec
G
G
Centre Régional de Lutte Contre le Cancer Jean Perrin, Clermont-Ferrand.
Charrier
S
S
Curé
H
H
Peffault de Latour
M
M
Ferrière
J P
JP
Chollet
P
P
Dauplat
J
J
D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome