Order of Initial Breast Cancer Treatment Does Not Affect Outcomes

October 2011, Vol 2, No 6

San Francisco, CA—Whether women receive chemotherapy or surgery first as their initial treatment for breast cancer does not affect long-term localregional recurrence, according to a large case series from the University of Texas M.D. Anderson Cancer Center, Houston, that was presented at the 2011 Breast Cancer Symposium.

“A woman can have chemotherapy or surgery first, and the choice will not affect her outcome,” said Elizabeth Ann Mittendorf, MD, a surgical oncologist at M.D. Anderson. “The molecular characteristics of the tumor and other factors have an impact on treatment success, but not the order in which chemotherapy and surgery is given.”

Their retrospective evaluation included 2984 women treated between 1987 and 2005 with segmental mastectomy and whole breast irradiation, including 78% who underwent surgery before chemotherapy and 22% who had neoadjuvant chemotherapy then surgery.

Dr Mittendorf reported that the rates of local-regional recurrence-free survival were excellent for both groups: at 5 years, 97% for the surgeryfirst group and 93% for the neoadjuvant chemotherapy group; at 10 years, 94% and 90%, respectively.

Even in patients who had ≥1 adverse features, such as later disease stage and higher tumor grade or estrogen- receptor–negative status, no survival differences were observed.

Neoadjuvant chemotherapy resulted in downgrading of tumor stage in almost half the patients, and therefore made breast-conserving therapy (ie, lumpectomy) possible in these women. Lumpectomy was performed in 69% of patients with stage II breast cancer who underwent neoadjuvant chemotherapy compared with 19% who had surgery first, and in 24% and 1%, respectively, of stage III patients (P <.001).

“Even women who present with clinical stage II or III disease may have good results with breast-conserving therapy after chemotherapy and not need a mastectomy,” Dr Mittendorf said.

Barbara Fowble, MD, of the University of California School of Medicine, San Francisco, the invited discussant of the abstract, said the study supports what has already been established by randomized controlled trials: the 2 approaches lead to comparable outcomes.—AA

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