Preoperative systemic therapy in locoregional management of early breast cancer: Highlights from the Kyoto Breast Cancer Consensus Conference
Journal
Breast Cancer Research and Treatment
Journal Volume
136
Journal Issue
3
Pages
919-926
Date Issued
2012
Author(s)
Toi M.
Benson J.R.
Winer E.P.
Forbes J.F.
Von Minckwitz G.
Golshan M.
Robertson J.F.R.
Sasano H.
Cole B.F.
Chow L.W.C.
Pegram M.D.
Han W.
Ikeda T.
Kanao S.
Lee E.-S.
Noguchi S.
Ohno S.
Partridge A.H.
Rouzier R.
Tozaki M.
Sugie T.
Yamauchi A.
Inamoto T.
Abstract
Data reviewed at the Kyoto Breast Cancer Consensus Conference (KBCCC) showed that preoperative systemic therapy (PST) could optimize surgery through the utilization of information relating to pre- and post-PST tumor stage, therapeutic sensitivity, and treatment-induced changes in the biological characteristics of the tumor. As such, it was noted that the biological characteristics of the tumor, such as hormone receptors, human epidermal growth factor receptor-2, histological grade, cell proliferative activity, mainly defined by the Ki67 labeling index, and the tumor's multi-gene signature, should be considered in the planning of both systemic and local therapy. Furthermore, the timing of axillary sentinel lymph node diagnosis (i.e., before or after the PST) was also noted to be critical in that it may influence the likelihood of axillary preservation, even in node positive cases. In addition, axillary diagnosis with ultrasound and concomitant fine needle aspiration cytology or core needle biopsy (CNB) was reported to contribute to the construction of a treatment algorithm for patient-specific or individualized axillary surgery. Following PST, planning for breast surgery should therefore be based on tumor subtype, tumor volume and extent, therapeutic response to PST, and patient preference. Nomograms for predicting nodal status and drug sensitivity were also recognized as a tool to support decision-making in the selection of surgical treatment. Overall, review of data at the KBCCC showed that PST increases the likelihood of patients receiving localized surgery and individualized treatment regimens. ? 2012 Springer Science+Business Media New York.
SDGs
Other Subjects
anthracycline; epidermal growth factor receptor 2; hormone receptor; Ki 67 antigen; taxane derivative; tetracycline derivative; article; axillary lymph node; breast cancer; breast surgery; cancer combination chemotherapy; cancer grading; cancer radiotherapy; cancer staging; cancer surgery; cancer survival; cell proliferation; clinical feature; clinical practice; early cancer; echography; fine needle aspiration biopsy; histopathology; human; lymph node dissection; medical decision making; nomogram; patient monitoring; patient preference; peroperative care; personalized medicine; priority journal; sentinel lymph node biopsy; sentinel lymph node metastasis; systemic therapy; treatment planning; treatment response; tumor volume; adjuvant therapy; algorithm; axilla; breast tumor; conference paper; consensus development; female; lymph node metastasis; metabolism; pathology; preoperative care; Algorithms; Axilla; Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Neoadjuvant Therapy; Nomograms; Preoperative Care; Sentinel Lymph Node Biopsy; Tumor Burden
Type
journal article