Breast cancer remains one of the most common cancers affecting women globally, prompting continued exploration of surgical options for treatment. Recent research has highlighted the effectiveness of breast-conserving surgery (BCS) compared to mastectomy following neoadjuvant chemotherapy (NAC). A large-scale study conducted between 2013 and 2023 evaluated local recurrence (LR), distant recurrence (DR), and mortality rates among patients receiving either surgical option.
The study examined 365 non-metastatic breast cancer patients who underwent either BCS (200 patients) or mastectomy (165 patients) after receiving NAC. The results showed comparable LR and DR rates across both surgical groups. Specifically, the LR rate was found to be 4.8% for mastectomy and 5.0% for BCS, with no statistically significant difference (p = 0.95). Distant recurrence rates were similarly close, at 10.9% for mastectomy and 9.0% for BCS (p = 0.58).
Notably, patients who opted for mastectomy experienced higher mortality rates: 8.5% had died compared to 3% of BCS patients. When evaluating ten-year survival rates, the study found excellence for the BCS group, with 98.5% LR-free survival compared to 95% for the mastectomy group (HR: 3.41; p = 0.03). Overall survival rates also reflected favorably for BCS at 97%, versus 91.5% for mastectomy (HR: 2.62; p = 0.03).
These findings support the growing body of evidence favoring BCS as a viable option following NAC, where higher quality of life outcomes have been demonstrated. Patients undergoing BCS reported improved quality of life due to less aggressive surgical intervention as well as faster recovery times compared to those undergoing mastectomy.
This research culminates from collaboration between the Fortaleza General Hospital and the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), conducted under the Brazilian National Health System (SUS). The study's authors noted the significance of NAC's impact on surgical choices, reflecting trends toward breast-conserving techniques even for patients with locally advanced breast cancer, traditionally deemed unsuitable for such methods.
The study included detailed retrospective analyses and multivariate evaluations considering variables such as age, tumor staging, and treatment type. Of note, patients with T3/T4 staging encountered higher LR rates (OR: 4.37; p = 0.04) and those receiving axillary dissection also showed increased risk (OR: 5.11; p = 0.04) within the BCS cohort. These determinants were pivotal for predicting outcomes and enhancing treatment discussions with patients.
Prior studies from earlier decades had indicated reservations about the safety of BCS post-NAC, often citing increased LR rates compared to mastectomy. The current findings go against this trend, reflecting advancements such as improved detection techniques, contemporary pharmacological therapies, and enhanced surgical methods contributing to lower recurrence rates.
Patients with aggressive tumor types, such as triple-negative breast cancer and HER2-positive tumors, particularly benefitted from the recent advances with NAC, yielding higher pathologic complete response (pCR) rates. The authors emphasized the advantages of newer chemotherapeutic agents which are now standard for NAC, underscoring their role not only in efficacy but also enhancing surgical options available to women.
The integration of imaging modalities has demonstrated potential improvements; for example, MRI and advanced ultrasound methods have allowed for more precise tumor localization during BCS. While NAC has traditionally been used to downstage tumors for surgical eligibility, increasing pCR rates have altered the surgical paradigm, allowing many patients previously considered for mastectomy to opt for BCS successfully.
Looking forward, the authors advocate for the need for more extensive studies to continue evaluating BCS as the primary surgical intervention following NAC, especially as additional Robinson warplanes emerge. Ensuring access to newer therapies and imaging technologies will be central to optimizing treatment outcomes for breast cancer patients.
This study adds to the body of knowledge illustrating the safety and effectiveness of BCS after neoadjuvant treatment, emphasizing its role as not just acceptable, but often preferred particularly for patients with favorable responses to NAC.
By exploring and documenting long-term outcomes, researchers provide invaluable insights to guide clinical practices, serve patient needs effectively, and re-evaluate stereotypes surrounding breast cancer treatments.