title: Preoperative chemotherapy for operable breast cancer improves surgical outcomes in the community hospital setting.
abstract: BACKGROUND
  Preoperative chemotherapy (PC) for operable breast cancer has demonstrated significant benefits in clinical trials. Many patients are treated in the community setting and some may question the applicability of PC outside the university setting. The potential benefits of PC in terms of surgical outcomes in a community practice were examined.
  
  
  METHODS
  A retrospective review was performed of stage II and stage IIIA breast cancer patients from January 1, 2002 to July 31, 2009. Surgical outcomes of margin status, volume of lumpectomy, rate of lumpectomy, and re-excision lumpectomy were evaluated.
  
  
  RESULTS
  There were 212 patients included. Seventy-nine percent of patients who underwent PC had a clinical response and 25% had a pathologic complete response. For clinical stage T2 and stage T3 tumors, the PC group underwent lumpectomy more often than patients in the adjuvant chemotherapy (AC) group (78% versus 50%; p = .016 and 60% versus 29%; p = .015, respectively). The rate of close or positive margins in the PC group was half the rate in the AC group (23% versus 46%; p = .04) and this resulted in fewer re-excisions (p = .01). The volume of tissue removed was also smaller in the PC group (143.6 cm³ versus 273.9 cm³; p = .003). Conclusions. PC for operable breast cancer can significantly improve surgical outcomes in community-based practice.
authors.affiliation: Maricopa Medical Center, Department of Surgery, Phoenix, Arizona, USA. Komenaka@hotmail.com
authors.forename: Ian K
authors.initials: IK
authors.lastname: Komenaka
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hibbard
authors.forename: Chiu-Hsieh
authors.initials: CH
authors.lastname: Hsu
authors.forename: Boo Ghee
authors.initials: BG
authors.lastname: Low
authors.forename: Jason A
authors.initials: JA
authors.lastname: Salganick
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Bouton
authors.forename: Chandra
authors.initials: C
authors.lastname: Jha
mesh_terms: D000328:Adult; D000368:Aged; D001130:Arizona; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery*; D002173:Cancer Care Facilities; D017024:Chemotherapy, Adjuvant; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008327:Mammography / Q000379:methods; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome