title: High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies.
abstract: The literature reports low rates of breast conservation after neoadjuvant chemotherapy for operable breast cancers not amenable to initial breast-conserving surgery. This study aims to compare the outcome of lobular vs ductal carcinomas after neoadjuvant chemotherapy. Between 1989 and 1999, 750 patients with clinical stage II/IIIA ductal (672) or lobular (78) invasive breast carcinomas were treated at the Institut Curie with primary anthracycline-based polychemotherapy followed by either breast conservation (surgery and/or radiotherapy) or mastectomy. Median follow-up was 10 years. Clinical response to primary chemotherapy was significantly worse for lobular than for ductal carcinomas (47 vs 60%; P=0.04), but only histological grade remained predictive in multivariate analysis. Breast conservation was high for both ductal and lobular carcinomas (65 and 54%; P=0.07), due, in part, to the use of radiotherapy, either exclusive or preoperative, for respectively 26 and 40% of patients. The lobular type had no adverse effect, neither on locoregional control nor on overall survival, even in the group of patients treated with breast conservation.
authors.affiliation: Department of Radiation Oncology, Institut Curie, Paris cedex 05, Paris 75248, France. marc.bollet@curie.net
authors.forename: M A
authors.initials: MA
authors.lastname: Bollet
authors.forename: A
authors.initials: A
authors.lastname: Savignoni
authors.forename: J-Y
authors.initials: JY
authors.lastname: Pierga
authors.forename: M
authors.initials: M
authors.lastname: Lae
authors.forename: V
authors.initials: V
authors.lastname: Fourchotte
authors.forename: Y M
authors.initials: YM
authors.lastname: Kirova
authors.forename: R
authors.initials: R
authors.lastname: Dendale
authors.forename: F
authors.initials: F
authors.lastname: Campana
authors.forename: B
authors.initials: B
authors.lastname: Sigal-Zafrani
authors.forename: R
authors.initials: R
authors.lastname: Salmon
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
authors.forename: A
authors.initials: A
authors.lastname: Vincent-Salomon
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate