title: Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up.
abstract: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer.
  A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival.
  Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01).
  Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.
authors.affiliation: Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Barretos/SP, Brazil.
authors.forename: Guilherme Freire Angotti
authors.initials: GF
authors.lastname: Carrara
authors.affiliation: Hospital de Câncer de Barretos, Departamento de Patologia, Barretos/SP, Brazil.
authors.forename: Cristovam
authors.initials: C
authors.lastname: Scapulatempo-Neto
authors.affiliation: Hospital de Câncer de Barretos, Departamento de Patologia, Barretos/SP, Brazil.
authors.forename: Lucas Faria
authors.initials: LF
authors.lastname: Abrahão-Machado
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Disciplina de Oncologia, Departamento de Radiologia, São Paulo/SP, Brazil.
authors.forename: Maria Mitzi
authors.initials: MM
authors.lastname: Brentani
authors.affiliation: Hospital de Câncer de Barretos, Departamento de Oncologica Clínica, Barretos/SP, Brazil.
authors.forename: João Soares
authors.initials: JS
authors.lastname: Nunes
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Disciplina de Oncologia, Departamento de Radiologia, São Paulo/SP, Brazil.
authors.forename: Maria Aparecida Azevedo Koike
authors.initials: MA
authors.lastname: Folgueira
authors.affiliation: Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Barretos/SP, Brazil.|Hospital de Câncer de Barretos, Programa de Pós-Graduação em Oncologia, Departamento de Mastologia e Reconstrução Mamária, Barretos/SP, Brazil.
authors.forename: René Aloisio da Costa
authors.initials: RA
authors.lastname: Vieira
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden