title: Long-term outcome of neoadjuvant endocrine therapy with aromatase inhibitors in elderly women with hormone receptor-positive breast cancer.
abstract: BACKGROUND
  Aromatase inhibitors (AIs) are more effective than tamoxifen as neoadjuvant endocrine therapy (NET) for hormone receptor (HR)-positive breast cancer. Here we report the surgical and long-term outcome of elderly postmenopausal patients with locally advanced, HR-positive breast cancer treated with preoperative AIs.
  
  
  METHODS
  Between January 2003 and December 2012, 144 postmenopausal patients inoperable with breast conservative surgery (BCS) received letrozole, anastrozole, or exemestane as NET. Patients underwent breast surgery and received adjuvant AIs. Adjuvant systemic therapy, chemotherapy and/or trastuzumab, and adjuvant radiotherapy were administered as appropriate, but limited to high-risk patients with few or no comorbidities.
  
  
  RESULTS
  After a median follow-up of 49 months, 4 (3.0 %) patients had local relapse, 18 (12.5 %) had distant metastases, and 24 (17.0 %) died. BCS was performed in 121 (84.0 %) patients. A tumor size <3 cm and human epidermal growth factor receptor 2 (HER2) negativity were predictors of BCS. The achievement of BCS and grade G1 were significantly associated with longer disease-free survival (DFS) (p = 0.009 and p = 0.01, respectively) and overall survival (p = 0.002 and p = 0.005, respectively). Residual tumor ≤2 cm (yT0-yT1) in the longest diameter after NET was also statistically associated with longer DFS (p = 0.005).
  
  
  CONCLUSIONS
  The results of this retrospective study indicate that elderly breast cancer patients with a tumor size <3 cm at diagnosis and HER2 negativity have a higher probability of achieving BCS after NET. Moreover, patients treated with BCS and with grade G1 tumor have a reduced risk of recurrence and death in the long-term follow-up.
authors: Medical Oncology Unit, Department of Experimental and Clinical Sciences, University 'G. d'Annunzio', Chieti, Italy.
authors: Antonino
authors: A
authors: Grassadonia
authors: Marta
authors: M
authors: Di Nicola
authors: Simona
authors: S
authors: Grossi
authors: Paolo
authors: P
authors: Noccioli
authors: Saveria
authors: S
authors: Tavoletta
authors: Roberto
authors: R
authors: Politi
authors: Domenico
authors: D
authors: Angelucci
authors: Camilla
authors: C
authors: Marinelli
authors: Marinella
authors: M
authors: Zilli
authors: Giampiero
authors: G
authors: Ausili Cefaro
authors: Nicola
authors: N
authors: Tinari
authors: Michele
authors: M
authors: De Tursi
authors: Laura
authors: L
authors: Iezzi
authors: Pasquale
authors: P
authors: Cioffi
authors: Stefano
authors: S
authors: Iacobelli
authors: Clara
authors: C
authors: Natoli
authors: Ettore
authors: E
authors: Cianchetti
mesh_terms: D000368:Aged; D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D018275:Carcinoma, Lobular / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077289:Letrozole; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009570:Nitriles / Q000627:therapeutic use; D017698:Postmenopause; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D012189:Retrospective Studies; D015996:Survival Rate; D013629:Tamoxifen / Q000627:therapeutic use; D013997:Time Factors; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000077384:Anastrozole; D000730:Androstadienes; D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D000077289:Letrozole; D009570:Nitriles; D018719:Erb-b2 Receptor Tyrosine Kinases; D013629:Tamoxifen; D014230:Triazoles; C508053:ERBB2 protein, human; C056516:exemestane