Is Breast Surgery Necessary for Breast Carcinoma in Complete Remission Following Neoadjuvant Chemotherapy?

Hannah Richter; André Hennigs; Benedikt Schaefgen; Markus Hahn; Jens Uwe Blohmer; Sherko Kümmel; Thorsten Kühn; Marc Thill; Kay Friedrichs; Christof Sohn; Michael Golatta; Jörg Heil

doi:10.1055/s-0043-124082

Geburtshilfe und Frauenheilkunde, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2018; 78(01): 48-53
DOI: 10.1055/s-0043-124082

GebFra Science

Review/Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Is Breast Surgery Necessary for Breast Carcinoma in Complete Remission Following Neoadjuvant Chemotherapy?

Artikel in mehreren Sprachen: English | deutsch

Hannah Richter

¹Brustzentrum der Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany

,

André Hennigs

¹Brustzentrum der Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany

,

Benedikt Schaefgen

¹Brustzentrum der Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany

,

Markus Hahn

²Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Germany

,

Jens Uwe Blohmer

³Brustzentrum der Klinik für Gynäkologie, Campus Charité Mitte, Berlin, Germany

,

Sherko Kümmel

⁴Brustzentrum der Kliniken Essen-Mitte, Evang. Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany

,

Thorsten Kühn

⁵Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen GmbH, Esslingen, Germany

,

Marc Thill

⁶Brustzentrum, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany

,

Kay Friedrichs

⁷Mammazentrum am Krankenhaus Jerusalem Hamburg, Hamburg, Germany

,

Christof Sohn

¹Brustzentrum der Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany

,

Michael Golatta

¹Brustzentrum der Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany

,

Jörg Heil

¹Brustzentrum der Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany

› Institutsangaben

Abstract

The likelihood of pathological complete remission (pCR) of breast cancer following neoadjuvant chemotherapy (NACT) is increasing; most of all in the triple negative and HER2 positive tumour subgroups. The question thus arises whether or not breast surgery is necessary when there is complete remission after NACT, and whether it provides any improvement of the oncological treatment result when tumour is no longer detectable. Avoiding surgery and possibly even radiotherapy would only be conceivable on the basis of a reliable diagnosis of pCR without operating. Current imaging does not achieve the necessary sensitivity and specificity to assure the diagnosis of pathological complete remission. Further studies are therefore required to determine which methods are best able to evaluate tumour response to NACT. Studies on image-guided, minimally invasive biopsies after NACT have delivered first promising results towards diagnosing pCR before surgery and could provide the basis for further studies on the possibility of avoiding surgery in this specific patient collective.

Key words

neoadjuvant chemotherapy - minimally invasive biopsies - breast cancer - diagnosis - surgery

Volltext

Referenzen

References/Literatur
1 Ellis P, Smith I, Ashley S. et al. Clinical prognostic and predictive factors for primary chemotherapy in operable breast cancer. J Clin Oncol 1998; 16: 107-114
2 Ring A, Webb A, Ashley S. et al. Is surgery necessary after complete clinical remission following neoadjuvant chemotherapy for early breast cancer?. J Clin Oncol 2003; 21: 4540-4545
3 Heil J, Schaefgen B, Sinn P. et al. Can a pathological complete response of breast cancer after neoadjuvant chemotherapy be diagnosed by minimal invasive biopsy?. Eur J Cancer 2016; 69: 142-150
4 van la Parra RF, Kuerer HM. Selective elimination of breast cancer surgery in exceptional responders: historical perspective and current trials. Breast Cancer Res 2016; 18: 28
5 De Lena M, Varini M, Zucali R. et al. Multimodal treatment for locally advanced breast cancer. Result of chemotherapy-radiotherapy versus chemotherapy-surgery. Cancer Clin Trials 1981; 4: 229-236
6 Perloff M, Lesnick GJ, Korzun A. et al. Combination chemotherapy with mastectomy or radiotherapy for stage III breast carcinoma: a Cancer and Leukemia Group B study. J Clin Oncol 1988; 6: 261-269
7 Scholl SM, Pierga JY, Asselain B. et al. Breast tumour response to primary chemotherapy predicts local and distant control as well as survival. Eur J Cancer 1995; 31A: 1969-1975
8 Touboul E, Buffat L, Lefranc JP. et al. Possibility of conservative local treatment after combined chemotherapy and preoperative irradiation for locally advanced noninflammatory breast cancer. Int J Radiat Oncol Biol Phys 1996; 34: 1019-1028
9 Mauriac L, MacGrogan G, Avril A. et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS). Ann Oncol 1999; 10: 47-52
10 Daveau C, Savignoni A, Abrous-Anane S. et al. Is radiotherapy an option for early breast cancers with complete clinical response after neoadjuvant chemotherapy?. Int J Radiat Oncol Biol Phys 2011; 79: 1452-1459
11 Chagpar AB, Middleton LP, Sahin AA. et al. Accuracy of physical examination, ultrasonography, and mammography in predicting residual pathologic tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg 2006; 243: 257-264
12 Shin HJ, Kim HH, Ahn JH. et al. Comparison of mammography, sonography, MRI and clinical examination in patients with locally advanced or inflammatory breast cancer who underwent neoadjuvant chemotherapy. Br J Radiol 2011; 84: 612-620
13 Marinovich ML, Houssami N, Macaskill P. et al. Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst 2013; 105: 321-333
14 Marinovich ML, Houssami N, Macaskill P. et al. Accuracy of ultrasound for predicting pathologic response during neoadjuvant therapy for breast cancer. Int J Cancer 2015; 136: 2730-2737
15 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
16 De Los Santos JF, Cantor A, Amos KD. et al. Magnetic resonance imaging as a predictor of pathologic response in patients treated with neoadjuvant systemic treatment for operable breast cancer. Translational Breast Cancer Research Consortium trial 017. Cancer 2013; 119: 1776-1783
17 Schaefgen B, Mati M, Sinn HP. et al. Can routine imaging after neoadjuvant chemotherapy in breast cancer predict pathologic complete response?. Ann Surg Oncol 2016; 23: 789-795
18 Schott AF, Roubidoux MA, Helvie MA. et al. Clinical and radiologic assessments to predict breast cancer pathologic complete response to neoadjuvant chemotherapy. Breast Cancer Res Treat 2005; 92: 231-238
19 Peintinger F, Kuerer HM, Anderson K. et al. Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol 2006; 13: 1443-1449
20 Chen JH, Feig B, Agrawal G. et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer 2008; 112: 17-26
21 Bhattacharyya M, Ryan D, Carpenter R. et al. Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer. Br J Cancer 2008; 98: 289-293
22 Keune JD, Jeffe DB, Schootman M. et al. Accuracy of ultrasonography and mammography in predicting pathologic response after neoadjuvant chemotherapy for breast cancer. Am J Surg 2010; 199: 477-484
23 Croshaw R, Shapiro-Wright H, Svensson E. et al. Accuracy of clinical examination, digital mammogram, ultrasound, and MRI in determining postneoadjuvant pathologic tumor response in operable breast cancer patients. Ann Surg Oncol 2011; 18: 3160-3163
24 Adrada BE, Huo L, Lane DL. et al. Histopathologic correlation of residual mammographic microcalcifications after neoadjuvant chemotherapy for locally advanced breast cancer. Ann Surg Oncol 2015; 22: 1111-1117
25 Matsuo K, Fukutomi T, Watanabe T. et al. Concordance in pathological response to neoadjuvant chemotherapy between invasive and noninvasive components of primary breast carcinomas. Breast Cancer 2002; 9: 75-81
26 Vinnicombe SJ, MacVicar AD, Guy RL. et al. Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. Radiology 1996; 198: 333-340
27 Fadul D, Rapelyea J, Schwartz AM. et al. Development of malignant breast microcalcifications after neoadjuvant chemotherapy in advanced breast cancer. Breast J 2004; 10: 141-145
28 Bossuyt V, Provenzano E, Symmans WF. et al. Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration. Ann Oncol 2015; 26: 1280-1291
29 Loo CE, Straver ME, Rodenhuis S. et al. Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype. J Clin Oncol 2011; 29: 660-666
30 Wang Y, Zhang C, Liu J. et al. Is 18F-FDG PET accurate to predict neoadjuvant therapy response in breast cancer? A meta-analysis. Breast Cancer Res Treat 2012; 131: 357-369
31 Clouth B, Chandrasekharan S, Inwang R. et al. The surgical management of patients who achieve a complete pathological response after primary chemotherapy for locally advanced breast cancer. Eur J Surg Oncol 2007; 33: 961-966
32 Rea D, Tomlins A, Francis A. Time to stop operating on breast cancer patients with pathological complete response?. Eur J Surg Oncol 2013; 39: 924-930
33 Kuerer HM, Rauch GM, Krishnamurthy S. et al. A clinical feasibility trial for identification of exceptional responders in whom breast cancer surgery can be eliminated following neoadjuvant systemic therapy. Ann Surg 2017;
34 Heil J, Kummel S, Schaefgen B. et al. Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques. Br J Cancer 2015; 113: 1565-1570
35 Kuerer HM, Vrancken Peeters M, Rea DW. et al. Nonoperative management for invasive breast cancer after neoadjuvant systemic therapy: conceptual basis and fundamental international feasibility clinical trials. Ann Surg Oncol 2017;