title: The safety of breast-conserving surgery in patients who achieve a complete pathologic response after neoadjuvant chemotherapy.
abstract: BACKGROUND
  The objectives of this study were to determine the locoregional recurrence (LRR) rate and to evaluate the correlation between surgical resection volume (RV) and LRR in patients with breast cancer who underwent segmental mastectomy after achieving a pathologic complete response (pCR) on neoadjuvant chemotherapy.
  
  
  METHODS
  The authors reviewed the outcomes of all 109 patients who underwent segmental mastectomy after the complete eradication of invasive disease by neoadjuvant chemotherapy at their institution between 1987 and 2002. LRRs were recorded, and RVs after segmental mastectomy were calculated and categorized as small, medium, or large.
  
  
  RESULTS
  At a median follow-up of 6.6 years, 3 patients (2.7%) developed LRR. In 2 of those patients, the recurrence was located in the ipsilateral breast; in the other patient, the recurrence was located in the supraclavicular lymph nodes with synchronous distant metastases. The median RV was 73.12 cm3 (range, 2.82-451.51 cm3). Large RVs (>125 cm3) were less common than small RVs (up to 70 cm3) or medium RVs (between 70 cm3 and 125 cm3; P = .009 and P<.0001, respectively). One patient with a small RV had an LRR at 4 years, and 2 patients with medium RVs had LLRs at 2.3 years and 6 years, respectively. The 5-year and 10-year LRR-free survival rates were 98.1% and 96.5%, respectively, and the corresponding overall survival rates were 96% and 92%, respectively.
  
  
  CONCLUSIONS
  Segmental mastectomy was associated with excellent locoregional control in patients who achieved a pCR after neoadjuvant chemotherapy. Prospective studies are needed to examine whether decreasing the RVs in this patient population leads to an increased LRR rate.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Florentia
authors.initials: F
authors.lastname: Peintinger
authors.forename: W Fraser
authors.initials: WF
authors.lastname: Symmans
authors.forename: Ana M
authors.initials: AM
authors.lastname: Gonzalez-Angulo
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.forename: Aman U
authors.initials: AU
authors.lastname: Buzdar
authors.forename: T Kuan
authors.initials: TK
authors.lastname: Yu
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: S Eva
authors.initials: SE
authors.lastname: Singletary
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D015203:Reproducibility of Results; D016019:Survival Analysis; D016896:Treatment Outcome