title: Breast conservation after neoadjuvant chemotherapy.
abstract: BACKGROUND
  The appropriate selection criteria for breast-conserving therapy (BCT) after neoadjuvant chemotherapy are poorly defined. The purpose of the current report was to develop a prognostic index to help refine selection criteria and to serve as a general framework for clinical decision-making for patients treated by this multimodality approach.
  
  
  METHODS
  From a group of 340 patients treated with BCT after neoadjuvant chemotherapy, the authors previously determined 4 statistically significant predictors of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR): clinical N2 or N3 disease, residual pathologic tumor size > than 2 cm, a multifocal pattern of residual disease, and lymphovascular space invasion in the specimen. The M. D. Anderson Prognostic Index (MDAPI) was developed by assigning scores of 0 (favorable) or 1 (unfavorable) for each of these 4 variables and using the total to give an overall MDAPI score of 0-4.
  
  
  RESULTS
  The MDAPI stratified the 340 patients into 3 subsets with statistically different levels of risk for IBTR and LRR after neoadjuvant chemotherapy and BCT. Actuarial 5-year IBTR-free survival rates were 97%, 88%, and 82% for patients in the low (MDAPI overall score 0 or 1, n=276), intermediate (MDAPI score 2, n=43), and high (MDAPI score 3 or 4, n=12) risk groups, respectively (P<0.001). Corresponding actuarial 5-year LRR-free survival rates were 94%, 83%, and 58%, respectively (P<0.001).
  
  
  CONCLUSIONS
  Patients with an MDAPI score of 0 or 1, which made up 81% of the study population, had very low rates of IBTR and LRR. The MDAPI enabled the identification of a small group (4%) of patients who are at high risk for IBTR and LRR and who may benefit from alternative locoregional treatment strategies.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Allen M
authors.initials: AM
authors.lastname: Chen
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Howard D
authors.initials: HD
authors.lastname: Thames
authors.forename: Elesyia D
authors.initials: ED
authors.lastname: Outlaw
authors.forename: Eric A
authors.initials: EA
authors.lastname: Strom
authors.forename: Marsha D
authors.initials: MD
authors.lastname: McNeese
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Fredrick C
authors.initials: FC
authors.lastname: Ames
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Aysegul A
authors.initials: AA
authors.lastname: Sahin
authors.forename: George H
authors.initials: GH
authors.lastname: Perkins
authors.forename: Gildy
authors.initials: G
authors.lastname: Babiera
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D016896:Treatment Outcome