American Surgical Association
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Impact of Pre-operative versus Post-operative Chemotherapy on the Extent and Number of Surgical Procedures in Patients Treated on Randomized Clinical Trials for Breast Cancer
Judy C. Boughey, MD*, Flori Peintinger, MD*, Funda Meric-Bernstam, MD*, Allison Perry, MS, PA-C*, Kelly K. Hunt, MD, Gildy V. Babiera, MD*, Isabelle Bedrosian, MD*, Aman U. Buzdar, MD*, Lajos Pusztai, MD, PhD*, Henry M. Kuerer, MD, PhD*
University of Texas MD Anderson Cancer Center, Houston, TX

Pre-operative chemotherapy is being used increasingly and results in increased rates of breast conserving therapy (BCT). The necessary extent of surgery following chemotherapy has never been fully defined. The extent of surgery in BCT patients has a direct impact on cosmesis. We hypothesized that patients receiving pre-operative chemotherapy would require less extensive surgery.
Between Sept 1998 and May 2005 we treated 509 consecutive patients with T1-T3 N0-N2 breast cancer on prospective randomized clinical chemotherapy trials. We analyzed the final surgical procedure (BCT or mastectomy), the number of operations, re-excision rates, and total volume of breast tissue excised [4 /3(width/2 × length/2 × height/2] to achieve negative margins.
241 patients underwent BCT and 268 patients underwent mastectomy. When matched for tumor size, patients with initial clinical tumor size >2.0 cm who underwent BCT after pre-operative chemotherapy had statistically smaller volumes of breast tissue excised compared to patients receiving post-operative chemotherapy (113 cm3 vs. 213 cm3, p= 0.004). The re-excision rate to obtain negative margins and total number of breast operations were not significantly different between groups. Patients with initial tumor size less than 2 cm showed no statistical difference in the number of operative procedures, re-excision rates or volume of breast tissue excised when undergoing BCT (p>0.05).
Patients with larger tumors treated with pre-operative chemotherapy undergo less extensive resection compared with patients treated with post-operative chemotherapy. This smaller volume of tissue resected does not lead to increased re-excision rates to obtain negative margins.
Tumor SizeVariablePost-op Chemo (n=89)Pre-op Chemo (n=150)p value
≤2.0 cmRe-excision rate16.2%8.3%p>0.05
Volume of breast tissue excised (cm3)98111p>0.05
>2.0 cmRe-excision rate14.3%14.3%p>0.05
Volume of breast tissue excised (cm3)213113p=0.0043

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