Breast Surgery Can Be Omitted After Neoadjuvant Systemic Therapy in Select Patients
By Elana Gotkine HealthDay Reporter
FRIDAY, April 11, 2025 -- Omission of breast surgery after neoadjuvant systemic therapy (NST) in select patients with invasive breast cancer may be feasible, according to a study published online March 28 in the Journal of the American Medical Association to coincide with the annual meeting of the Society of Surgical Oncology, held from March 27 to 29 in Tampa, Florida.
Henry M. Kuerer, M.D., Ph.D., from The University of Texas MD Anderson Cancer Center in Houston, and colleagues reported five-year efficacy outcomes evaluating radiotherapy alone without breast surgery in a prospective, nonrandomized clinical trial involving women aged 40 years or older with cT1-2N0-1M0 ERBB2-positive or triple-negative invasive breast cancer selected using image-guided vacuum-assisted biopsy (VAB). Fifty patients were enrolled and underwent VAB after standard NST. Patients with residual cancer on VAB had standard breast and axillary surgery, while those with initial documented nodal disease and a breast pathological complete response (pCR) on VAB underwent targeted axillary dissection.
Overall, 58 and 42 percent of patients had ERBB2-positive and triple-negative invasive breast cancer, respectively. The researchers identified breast pCR on VAB in 31 patients (62 percent); all eight patients with initial nodal metastases and breast pCR on VAB who underwent targeted axillary dissection had axillary pCR. The ipsilateral breast tumor recurrence rate was 0 percent at a median follow-up of 55.4 months; for patients without breast surgery, disease-free and overall survival rates were 100 percent.
"The methods used in the current study taken together with additional results from future studies could represent the commencement of a paradigm shift in the surgical management of breast cancer after NST," the authors write.
Several authors disclosed ties to the pharmaceutical and health technology industries.
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Posted April 2025
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