title: Neoadjuvant chemotherapy in invasive lobular carcinoma may not improve rates of breast conservation.
abstract: BACKGROUND
  Patients with invasive lobular carcinoma (ILC) experience a lower pathological complete response rate to neoadjuvant chemotherapy than patients with invasive ductal carcinoma. This study was intended to evaluate the impact of neoadjuvant chemotherapy in ILC on breast-conserving surgery (BCS) rates.
  
  
  METHODS
  Two-hundred eighty-four consecutive patients with pure ILC treated between May 1998 and September 2006 were reviewed. Surgical procedures and long-term outcomes were compared between patients receiving neoadjuvant chemotherapy and those receiving surgery first.
  
  
  RESULTS
  Neoadjuvant chemotherapy was administered to 84 patients; 200 patients underwent surgery first. The mean tumor size in the neoadjuvant group (4.9 cm) was significantly larger than in patients who underwent surgery first (2.5 cm, p < 0.0001). In the neoadjuvant group, clinical complete response was seen in 10% and partial response in 59%. Overall BCS rates were 17% in the neoadjuvant group compared with 43% in the surgery-first group (p < 0.0001). When controlled for initial tumor size, there was no difference (all p > 0.05) between the groups in terms of (1) the proportion of patients who underwent an initial attempt at BCS, (2) rate of failure of BCS or (3) the proportion of patients undergoing BCS as their final procedure. With a mean follow-up of 47 months, local recurrence (LR) rates were similar between the two groups (1.2% versus 0.5%, p = 0.5).
  
  
  CONCLUSIONS
  The use of neoadjuvant chemotherapy does not increase the rates of breast conservation in patients with pure ILC.
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, USA.
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.forename: Jamie
authors.initials: J
authors.lastname: Wagner
authors.forename: Betsy J
authors.initials: BJ
authors.lastname: Garrett
authors.forename: Lori
authors.initials: L
authors.lastname: Harker
authors.forename: Lavinia P
authors.initials: LP
authors.lastname: Middleton
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.forename: Funda
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents