title: Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients With Locally Advanced Breast Cancer Requiring Initial Mastectomy.
abstract: BACKGROUND
  The aim of this study was to assess the rate of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (nCT) in patients for whom mastectomy (MT) was, initially, the only conceivable surgical option.
  
  
  METHODS
  Between 2007 and 2012, 168 patients from a single center received nCT. Among these patients, we focused on the ones who received nCT (n = 119, [70.8%]) to decrease tumor size and thus to potentially allow a conservative surgical treatment. For these patients, MT was initially the only possible surgical treatment.
  
  
  RESULTS
  Among the 119 patients included, 118 presented with an invasive ductal carcinoma. The mean tumor size before nCT, measured using magnetic resonance imaging, was 41.6 mm (range, 15-110 mm) and 25.3 mm (range, 0-90 mm) after nCT. Eighty-six patients (72.3%) underwent BCS, and oncoplastic techniques were used in 29 patients (33.6%). Only 4.3% (5 patients) of patients who were treated with BCS needed additional surgery because of positive surgical margins. The median follow-up was 41.1 months (95% confidence interval [CI], 35.2-48.3). Five-year overall survival after BCS and MT were 77% (95% CI, 63-92) and 77% (95% CI, 63-95) respectively. Five-year disease-free survival after BCS and MT were 74% (95% CI, 64-86) and 59% (95% CI, 40-89) (not significant), respectively.
  
  
  CONCLUSIONS
  nCT for selective patients with "chemosensitive" breast tumor leads to a significant "MT to BCS" conversion rate. The type of surgery does not seem to affect the patient's overall and disease-free survival rates. Oncoplastic procedures can help to extend BCS after nCT.
authors.affiliation: Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France. Electronic address: emmanuel.barranger@nice.unicancer.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.affiliation: Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Antomarchi
authors.affiliation: Département de recherche Clinique et innovation et statistiques, Centre Antoine Lacassagne, Nice, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chamorey
authors.affiliation: Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Cavrot
authors.affiliation: Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Flipo
authors.affiliation: Département d'oncologie médicale, Centre Antoine Lacassagne, Nice, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Follana
authors.affiliation: Département d'anatomie-pathologique, Centre Antoine Lacassagne, Nice, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Peyrottes
authors.affiliation: Département de radiologie, Centre Antoine Lacassagne, Nice, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Chapellier
authors.affiliation: Département d'oncologie médicale, Centre Antoine Lacassagne, Nice, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Ferrero
authors.affiliation: Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France.
authors.forename: Tarik
authors.initials: T
authors.lastname: Ihrai
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D016896:Treatment Outcome
keywords: Breast-conserving treatment; Loco-regional recurrence; Neoadjuvant chemotherapy; Oncoplastic surgery; Survival