Breast conservation treatment in women with locally advanced breast cancer – Experience from a single centre

IntroductionIn absence of randomized evidence to support safety of conservative surgery (BCT) in locally advanced breast cancer (LABC), we analyzed a cohort of 664 women with LABC treated during January 1998 to December 2002 at Tata Memorial Hospital, Mumbai, India.Materials and methodsAll were treated with a multimodality regimen comprising of neoadjuvant chemotherapy (NACT) followed by surgery (modified radical mastectomy or BCT) and adjuvant radiotherapy and hormone therapy. The outcome was evaluated to assess safety of BCT.Results71% (469/664) women responded to NACT (22% clinical CR and 49% PR) and 28.3% (188/664) underwent BCT. Positive lumpectomy margins were reported in 8.5%, with gross presence of tumor at the margins in 2.3% requiring a revision surgery. At a median follow-up of 30 months, local relapse rate was 8% after BCT and 10.7% after mastectomy. The 3-year local DFS was better post-conservation than after mastectomy (87% vs 78%, P = 0.02). The disease-free survival (DFS) was also superior after BCT, 72% vs 52% (P < 0.001) at 3 years and 62% vs 37% (P < 0.001) at 5 years respectively. On multivariate analysis, presence of lymphatic vascular emboli (LVE) was the major significant predictor of local recurrence (P < 0.001, HR 2.52, 95% CI 1.52–4.18). DFS was better after BCT [(P < 0.001, HR 2.0 (95% CI 1.38–2.91)]; shorter DFS was noted in LVE positive (HR 1.54, P = 0.007) and larger residual disease after NACT (HR 1.13, P = 0.001).ConclusionBCT is technically feasible and safe post neo-adjuvant chemotherapy in women with LABC with no detriment in outcome.