Abstract P3-13-25: Oncoplastic breast surgery is oncologically safe in locally advanced breast cancer after neoadjuvant chemotherapy, an Egyptian experience
Authors: Youssef M , Namour A , Youssef O , Morsi A 
Published: May 2019

Background:

Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing mastectomy and re-excision rates, while avoiding breast deformities. OPS integrates plastic surgery techniques for immediate reshaping after wide excision for breast cancer. This techniques is emerging and our experience in Egypt has been gradually increasing. Our aim was to extend the applicability of OPS into more advanced tumours following neoadjuvant chemotherapy.

Method:

A prospective feasibility cohort study of OPS after neoadjuvant chemotherapy was carried at the national Cancer institute – Cairo University and included 40 patients. We aimed to look at long term oncologic safety and cosmetic outcomes.

The primary outcome was the local recurrence rate. Secondary outcomes included survival and margins obtained as well as cosmetic outcomes. Survival analysis was performed with Kaplan-Meir curves. Cosmetic outcomes were assessed using a modified Breast Q questionnaire (EORTC 10801).

Results:

40 patients were included in this study. All were diagnosed with locally advanced breast cancer between September 2012 and January 2015 at the National Cancer Institute – Cairo University. All were treated primarily with neoadjuvant chemotherapy (Anthracycline-based). The median age was 44.45 (Range 22- 65) years with median follow-up period of 42 (Range 24 – 60) months.

27.5% showed complete pathological response. 62.5% of patients had a level I OPS procedure, 10% had a level II procedure, and 27.5% had a volume replacement procedure with a Latissimus Dorsi flap.

The median resection margins with level I, level II, and volume replacement were 10 mm,25 mm and 15 mm respectively. The difference in margins between level I and II was statistically significant (p = 0.028), so was the difference between the 3 types of procedures (p = 0.035).

Three patients (7.5%) had local recurrence and required mastectomy; at 11, 13 and 16 months respectively. One of those (2.5%) developed distant bone metastasis.

Cumulative disease-free survival (DFS) for the whole cohort was 90.2%. Overall survival (OS) was 100% as there was no mortality reported during the follow-up period. Cumulative disease-free survival for patients with level I surgery was 85.4% while for those with level II and volume replacement it was 100% with no statistically significant difference (p = 0.2) because of small number of events.

The cumulative disease-free survival when the median resection margin obtained was less than 20 mm was 86.3%, whereas when the median margin was equal or more than 20 mm, it was 100%. This difference was not statistically significant (p = 0.2).

The cosmetic outcomes ranged between excellent result (70%), very good (15%), good (10%) and poor results (5%) on a very simplified scale that was used for the purpose of the study.

Discussion:

Oncoplastic breast surgery didn't compromise oncologic safety in the patients included in the study. The local recurrence rate, the DFS and OS were all within acceptable ranges .It even allowed wider margins of resection which could be associated with better oncologic outcomes. At the same time, it gave a better cosmetic outcome and therefore higher patient satisfaction.

Citation Format: Youssef M, Namour A, Youssef O, Morsi A. Oncoplastic breast surgery is oncologically safe in locally advanced breast cancer after neoadjuvant chemotherapy, an Egyptian experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-25.