title: Is surgery necessary after complete clinical remission following neoadjuvant chemotherapy for early breast cancer?
abstract: OBJECTIVE
  This retrospective analysis aimed to identify whether breast cancer patients receiving radiotherapy alone following a complete clinical remission (cCR) to neoadjuvant chemotherapy had a worse outcome than those treated with surgery.
  
  
  METHODS
  One hundred thirty-six patients who had achieved a cCR to neoadjuvant chemotherapy for early breast cancer were identified from a prospectively maintained database of 453 patients. Of these, 67 patients had undergone surgery as their primary locoregional therapy, and 69 patients had radiotherapy alone. Outcome was assessed in relation to local recurrence-free survival, disease-free survival, and overall survival.
  
  
  RESULTS
  Median follow-up was 63 months in the surgery group and 87 months in the no surgery group. Prognostic characteristics were well balanced between the two groups. For surgery and no surgery, respectively, there were no significant differences in disease-free survival or overall survival (5-year, 74% v 76%; 10-year, 60% v 70%, P =.9) between the two groups. There was a nonsignificant trend toward increased locoregional-only recurrence for the no surgery group (21% v 10% at 5 years; P =.09), but no long-term failures of local control. Patients in the no surgery group who also achieved an ultrasound complete remission had a 5-year local recurrence rate of only 8%.
  
  
  CONCLUSIONS
  In patients achieving a cCR to neoadjuvant chemotherapy, radiotherapy alone achieve survival rates as good as with surgery, but with higher local recurrence rates. Ultrasound may identify a low recurrence rate subgroup for assessing no surgery in a prospective trial.
authors.affiliation: Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Ring
authors.forename: A
authors.initials: A
authors.lastname: Webb
authors.forename: S
authors.initials: S
authors.lastname: Ashley
authors.forename: W H
authors.initials: WH
authors.lastname: Allum
authors.forename: S
authors.initials: S
authors.lastname: Ebbs
authors.forename: G
authors.initials: G
authors.lastname: Gui
authors.forename: N P
authors.initials: NP
authors.lastname: Sacks
authors.forename: G
authors.initials: G
authors.lastname: Walsh
authors.forename: I E
authors.initials: IE
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D002945:Cisplatin; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D003520:Cyclophosphamide; D008942:Mitoxantrone; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate