[Association of taxanes and radiotherapy: preclinical and clinical studies]

Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

OBJECTIVE:

To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer.

METHODS:

A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival.

RESULTS:

Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01).

CONCLUSIONS:

Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.

The role of oncoplastic breast conserving treatment for locally advanced breast tumors. A matching case-control study

Background

Breast conserving surgery (BCS) after neoadjuvant chemotherapy (NC) in patients with locally advanced breast cancer (LABC) is an infrequent procedure. In these patients the association with BCS and oncoplastic surgery (OS) is reported as a possible procedure in case-series, but there are limited case-control studies.

Methods

A matched case-control study evaluated LABC submitted to NC and BCS. We evaluated 78 patients submitted to doxorubicin-cyclophosphamide regimen followed by paclitaxel regimen. The match case-control proportion was 2:1 and the patients were selected by tumor size, clinical T stage and year of diagnosis.

Results

52 underwent classic BCS and 26 OS. The average size tumor was 5.25 cm and 88.5% of the tumors were larger than 3 cm. The clinical and pathological group characteristics were similar, except the weight of surgical specimens (p = 0.004), and surgical margins (p = 0.06), which were higher in OS group. The rate of complete pathologic response was 26.9%. 97.4% received postoperative radiotherapy. At 67.1 months of follow up, 10.2% had local recurrence (LR) and 12.8% locoregional recurrence (LRR) and 19.2% died because disease progression. The overall survival at 60 months was 81.7%. After surgery the disease free-survival at 60 months was 76.5%. The was no difference between groups related to pathologic response (p = 0.42), LR (p = 0.71), LRR (p = 1.00), overall survival (p = 0.99) and disease specific survival (p = 0.87).

Conclusion

This study corroborates the fact that OS is a safety procedure for LABC, offering the similar oncologic results observed in patients submitted to classic BCS.

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A matched case-control study evaluates oncoplastic techniques for locally advanced breast cancer.

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The size of tumors were bigger than other series.

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The matched case-control study was selected base on tumor size and year of diagnosis to decrease possible bias selection.

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The security of this procedure was evaluated based a long follow up.

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Oncoplastic surgery has the same results than conventional breast conserving surgery for locally advanced breast tumors.

Clinical effects of docetaxel chemotherapy combined with radiotherapy in the treatment of esophageal cancer: A systematic review

AIM: To compare the efficacy and safety of docetaxel chemotherapy combined with radiotherapy versus radiotherapy only in the treatment of esophageal cancer.

METHODS: Controlled trials that evaluated clinical effects of docetaxel chemotherapy combined with radiotherapy versus radiotherapy alone in the treatment of esophageal cancer were electronically searched from the CBM (1978-2011) and CNKI (1979-2011) databases, and the relevant published and unpublished data and their references in Chinese were also searched manually. The data were extracted and the methodological quality of the incorporated research was evaluated by two reviewers independently. The RevMan 5.1 software was used for meta-analysis.

RESULTS: Ten controlled trials involving 378 patients were included. Meta-analysis showed that compared with radiotherapy alone, docetaxel chemotherapy combined with radiotherapy was associated with better complete remission [RR = 2.12, 95%confidenceinterval (CI) (1.39, 3.25), P = 0.0005], short-term efficacy [RR = 3.56, 95%CI (1.97, 6.42), P < 0.0001], 1-year survival rate [RR = 2.64, 95%CI (1.17, 5.97), P = 0.02], and significantly improved grade 1 gastrointestinal reactions [RR = 0.37, 95%CI (0.17, 0.80), P = 0.01]. There were no significant differences in the rate of partial remission [RR = 1.05, 95%CI (0.69, 1.59), P = 0.83], 3-year survival rate [RR = 2.21, 95%CI (1.16, 4.22), P = 0.02], grades 0, 1, 2 and 3 gastrointestinal reactions [RR = 0.78, 95%CI (0.35, 1.73), P = 0.55; RR = 2.05, 95%CI (0.92, 4.59), P = 0.08; RR = 1.08, 95%CI (0.49, 2.39), P = 0.84; RR = 1.45, 95%CI (0.54, 3.90), P = 0.46], grades 0, 1, 2, 3 and 4 hematologic toxicities [RR = 0.55, 95%CI (0.26, 1.13), P = 0.10; RR = 1.00, 95%CI (0.48, 2.10), P = 1.00; RR = 1.26, 95%CI (0.58, 2.74), P = 0.56; RR = 1.29, 95%CI (0.48, 3.51), P = 0.61; RR = 3.09, 95%CI (0.31, 30.50), P = 0.33], and grades 2 and 3 esophageal mucosal reactions [RR = 1.20, 95%CI (0.60, 2.39), P = 0.60; RR = 1.27, 95%CI (0.49, 3.30), P = 0.63].

CONCLUSION: Docetaxel chemotherapy combined with radiotherapy is better than radiotherapy only in the treatment of esophageal cancer in terms of the overall curative effect. Because of a small number of studies in the incorporated research, the above conclusion is still validated by carrying out reasonably more randomized controlled trials with the multiple center sample.