Impact of oncoplasty in increasing breast conservation rates Post neo-adjuvant chemotherapy

• Authors: Chaitanyanand B. Koppiker, International School of Oncoplasty; Devaki A. Kelkar, Prashanti Cancer Care Mission; Madhura Kulkarni, Prashanti Cancer Care Mission; Shweta Kadu, Prashanti Cancer Care Mission; Mugdha Pai, Prashanti Cancer Care Mission; Upendra Dhar, Jehangir Hospital; Chetan Deshmukh, Jehangir Hospital; Beenu Varghese, Jehangir Hospital; Vaishali Zamre, International School of Oncoplasty; Nutan Jumle, Jehangir Hospital; Nutan Gangurde, Prashanti Cancer Care Mission; Anjali Joshi, Prashanti Cancer Care Mission; Rohini Unde, Prashanti Cancer Care Mission; Rituja Banale, Prashanti Cancer Care Mission; Namrata Namewar, Prashanti Cancer Care Mission; Pooja Vaid, Ashoka University; Laleh Busheri, Prashanti Cancer Care Mission; George Thomas, Prashanti Cancer Care Mission; Smeeta Nare, Prashanti Cancer Care Mission; Jerome Pereira, University of East Anglia; Sunil Badve, Emory University
• Journal Title: Frontiers in Oncology
• Volume: Volume 13
• Publisher: Frontiers | 2023-09-07, Pages 1176609-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3389/fonc.2023.1176609
• Subjects: Health Sciences, Oncology
• Keywords: neoadjuvant chemotherapy; breast cancer; breast conservation for large tumors; mastectomy; oncoplastic breast conservation; frozen section analysis; tumor localization

Abstract

Introduction The essential goal of neoadjuvant chemotherapy (NACT) is to downstage the primary tumor making it amenable for breast conservation surgery (BCS). However, since the safety of this surgery is paramount, post-NACT breast conservation rates remain low. As per the recommendation of the 2018 Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) overview of long-term post-NACT follow-up, we have devised a protocol for imaging, localization, rad-path analysis, and documentation of radiotherapy techniques to ensure the safety of post-NACT breast conservation. Methods This is a retrospective cohort of 180 breast cancer patients who received NACT and were operated on by a single surgical oncologist from 2015 to 2020. After selection based on published guidelines, patients were treated with neoadjuvant systemic (chemo or hormone) therapy. In cases where primary tumors responded and reduced to 1–2 cm in size mid-NACT, the residual tumors were localized by clips under ultrasound guidance and calcification was wire localized. All patients were treated using appropriate surgical and oncoplastic techniques where indicated. Negative margins were ensured by intra-operative rad-path analysis. Adjuvant chemotherapy and radiotherapy were given as per protocol. Results In 81 cases that required mastectomy at presentation, we were able to achieve a 72.8% post-NACT BCS rate with the help of oncoplasty. Overall, 142 of 180 (80%) patients were treated with breast conserving surgery of which 80% (121 of 142) were oncoplasty. Margins were assessed on intra-operative frozen and re-excised in the same setting. No positive margins were reported in final histopath of 142 breast conservation procedures. Post-operative complication rates after breast conservation in the first year were at 17% (24 of 142 including two major complications). Patient reported outcomes were satisfactory with increased satisfaction for breast conservation compared with immediate breast reconstruction. Discussion Employing oncoplastic breast surgery (OBS) techniques following stringent protocols for accurate localization of the residual tumor, intra-operative rad-path analysis, and adjuvant treatments, we show successful breast conservation in 72.8% of our mastectomy-qualified patients after downstaging by NACT. We also report satisfactory outcomes for post-NACT surgery, patient-reported satisfaction, and survival.