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Master Thesis

Surgical management after neoadjuvant systemic therapy in invasive lobular carcinoma of the breast: experience in a french referral center

Abstract : Introduction: invasive lobular carcinoma (ILC) is the second most common breast cancer, accounting approximately 15% of all breast cancer. It represents a singular disease because of its histopathological features, hardly palpable and discernible on imagery, thefore with a potential underestimated size. It appears more frequently with positive margins after breast conserving-surgery compared to invasive ductal carcinoma (IDC) and seems to induce repetitive surgery or mastectomy to obtain clear margins. The main objective of the study was to analyse in daily practice the impact of neoadjuvant systemic therapy (NST) on surgical procedure for patients with locally advanced ILC of the breast. The secondary objectives were to analyse predictive factors to improve surgery choice and observe breast reconstruction, recurrence and survival to inform patients for decision making. Method: A retrospective unicentric study was realised in the “Institut Bergonié” of Bordeaux. Patients were included if ILC of the breast was found on the first biopsy between 2008 and 2018 and if patients were eligible for an initial mastectomy or NST with initial clinical staging between T1c and T4c. Patients were excluded if they had other pre-operative treatment (radiation therapy, targeted therapy), synchron IDC, metastatic disease, multicentric tumor. Patients, tumors characteristics and sizes, neoadjuvant treatments, surgery and follow-up were recorded in each NST group (chemotherapy (NACT) or endocrine therapy (NAET)). Results: 193 patients were included, 152 patients received NAET and 41 received NACT. Breast-conserving surgery was performed on average for 55% of patients (53.3% after NAET and 58.8% after NACT). First BCS was carried out on average for 67.4% patients (67.8% after NAET and 65.9% after NACT), rate of re-operation for a final mastectomy among those patients was approximately 20% in our two groups (21.4% after NAET and 11.1% after NACT). Sentinel lymph nodes dissection alone was carried out for 17.1% of patients and 81.3 % were finally offered axillary node dissection. Final surgical procedure was similar between patients who received NAET vs NACT. NAET was the only potential risk factor for positive margins after BCS (p=0.03) and initial clinical stage ≥T3 was significantly associated with higher mastectomy risk (p=0.003). No imaging permitted to precisely predict tumor size before surgery. Breast reconstruction was carried out for few patients (21.6%) after mastectomy, mostly for young patients and during a delayed surgery. Survival did’nt significantly differed as per surgery achieved or NST used and low number of loco-regional events were reported in our overall population (8 patients). Conclusion: The use of NST, tailored to the initial characteristics of the tumor, in case of large ILC of the breast avoided approximately 55% mastectomies initially expected which motivated us to pursue our actual practices.
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https://dumas.ccsd.cnrs.fr/dumas-03382307
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Submitted on : Monday, October 18, 2021 - 10:39:06 AM
Last modification on : Thursday, November 25, 2021 - 3:15:46 AM

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  • HAL Id : dumas-03382307, version 1

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Julie Menard. Surgical management after neoadjuvant systemic therapy in invasive lobular carcinoma of the breast: experience in a french referral center. Life Sciences [q-bio]. 2021. ⟨dumas-03382307⟩

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