Abstract PS1-57: Mastectomy versus breast conserving surgery for the management of locally advanced breast cancer
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AbstractBackground: Breast conserving surgery (BCS) has become increasingly employed as a surgical option for patients with locally advanced breast cancer (LABC). However, guidelines on selecting appropriate LABC patients for BCS remain vague. Methods: Our Local Integrated Health Network (LHIN) conducted a multidisciplinary conference, known as the LHIN4 day, during which consensus criteria on which LABC patients may be safely offered BCS were established. These criteria included: clinical T3 or smaller, clinical and/or radiographic response to neoadjuvant therapy, patient seen by radiation oncology and deemed a candidate for post-operative radiation, and surgeon confident that negative margins could be achieved. A retrospective chart review was then performed of patients treated with neoadjuvant systemic therapy for LABC in the one year before, and three years after the LHIN4 day, which was between June 2015 and June 2019. Objectives: The primary objective of this study was to determine the rates of local and distant breast cancer recurrence in LABC patients treated with BCS using our consensus guidelines. The secondary objectives were: (1) to determine if there was an increase in BCS being performed following the LHIN4 educational day as compared to before this day, (2) to determine the rates of mastectomy followed by reconstruction among the patients treated within the past 3 years, and (3) to determine the rates of pathologic complete response (PCR). Results: A total of 391 patients were included in this study. Among the 26 patients who underwent BCS, the rate of local recurrence was 0% (0/26), and the rate of distant recurrence was 12% (3/26). Rates of BCS were 1.9% (2/108) before the LHIN4 day, and 8.5% (24/283) after the LHIN4 day. Rates of mastectomy followed by reconstruction were 12% (21/181) in the last 3 years. PCR was achieved in 15% (58/391) of all patients, of which 57% (33/58) were Her2 positive and 24% (14/58) were triple negative. Conclusion: We propose specific criteria for appropriately selecting LABC patients for BCS. Our results indicate that these criteria can be feasibly applied with low rates of local and distant breast cancer recurrence. A minority of patients with LABC who do not undergo BCS, either due to ineligibility or personal preference, are opting for mastectomy with reconstruction.Citation Format: Roochi Arora, Ghazaleh Kazemi, Graydon Lucas. Mastectomy versus breast conserving surgery for the management of locally advanced breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-57.
