Pathological complete response in invasive breast cancer treated by skin sparing mastectomy and immediate reconstruction following neoadjuvant chemotherapy and radiation therapy: Comparison between immunohistochemical subtypes.

CONTEXT: Even if neoadjuvant chemotherapy (NACT) and oncoplastic techniques have increased the breast conserving surgery rate, mastectomy is still a standard for multifocal or extensive breast cancers (BC). In the prospect of increasing breast reconstruction, an alternative therapeutic protocol was developed combining NACT with neoadjuvant radiation therapy (NART), followed by mastectomy with immediate breast reconstruction (IBR). The oncological safety of this therapeutic plan still needs further exploration. We assessed pathological complete response (pCR) as a surrogate endpoint for disease free survival. METHODS: Between 2010 and 2016, 103 patients undergoing mastectomy after NACT and NART were recruited. After CT and RT were administrated, a completion mastectomy with IBR by latissimus dorsi flap was achieved 6 to 8 weeks later. pCR was defined by the absence of residual invasive disease in both nodes and breast. Histologic response was analyzed for each immunohistochemical subset. RESULTS: pCR was obtained for 53.4% of the patients. This pCR rate was higher in hormonal receptor negative (HER2 and triple negative) patients when compared to luminal tumours (69.7% vs 45.7%, p=0.023). DISCUSSION: The pCR rate found in this study is higher than those published in studies analyzing NACT (12.5%-27.1%). This can be explained by the combination of anthracycline and taxane, the use of trastuzumab when HER2 was overexpressed but also by RT associated to NACT. CONCLUSION: Inverting the sequence protocol for BC, requiring both CT and RT, allows more IBR without diminishing pCR and should therefore be considered as an acceptable therapeutic option.

Angiosarcoma after conservative treatment and radiation therapy for adenocarcinoma of the breast.

Radio-induced angiosarcoma of the breast after conservative therapy for invasive adenocarcinoma is a very rare tumour. Between 1996 and 2000, four cases were operated in our Department of Surgical Oncology. After a review of the literature over the same period of time, natural history and treatment of radio-induced angiosarcomas of the breast were analysed.

[Conservative surgery for T2 > 3 cm, T3 N0 N1 M0 breast cancer after induction chemotherapy]. / La chirurgie conservatrice des cancers du sein T2 > 3 cm, T3 N0 N1 M0 après chimiothérapie d'induction.

Induction chemotherapy (IC) provides in more than 20% of cases a complete shrinkage of the tumor. This down staging is a new challenge for the surgeons for breast conservative procedure. Although, IC has become the standard of care for breast cancer T2 > 3 cm T3 N0 N1 M0. No guidelines have devoted attention to the surgical problems due to this down staging after IC. Location and size of the tumor before IC have to be studied and outlined by the surgeon himself. During surgery, the residual tumor volume and how much mammary gland must be removed are very difficult to determine. The maximum volume of mammary gland to be removed after IC around the primary site of the tumor before IC is the volume which permits a good cosmetic reconstruction of the breast. After IC, in spite of an important downstaging, an axillary clearance must be done. For N0 patients, sentinel lymph node biopsy could be performed before IC. If the sentinel node is p N0, axillary clearance could be avoided.

[Complete remission after abdominal wall metastasis from uterine cervical cancer on a laparoscopic trochar site: a case report]. / Rémission complète après métastase pariétale sur trajet de trocart de coelioscopie d'un cancer du col utérin. A propos d'un cas.

Abdominal wall metastasis to laparoscopic trochar sites after preoperative staging procedure is rare for uterine cervix cancer. Prognosis is unfavorable. We report a case of metastasis to a laparoscopic trochar site in a patient with a stage IIB cervical cancer with no nodal involvement who is alive four and a half years after radical surgery and radiotherapy.

[Pelvic and para-aortic lymphadenectomy in epithelial ovarian cancer. Report of a series of 86 cases]. / La lymphadénectomie lombo-aortique et pelvienne dans les cancers épithéliaux de l'ovaire. A propos d'une série de 86 cas.

AIM OF THE STUDY: The impact of lymphadenectomy in therapeutic strategy of ovarian carcinomas is strongly debated. The aim of this retrospective study was to report a series of 86 patients with ovarian carcinoma who underwent pelvic and paraaortic lymphadenectomy. PATIENTS AND METHOD: From 1993 to 1998, a retroperitoneal lymphadenectomy was performed in 86 patients (median age: 54 years) during the first laparotomy (n = 52) or later (n = 34) for ovarian carcinoma stade I and II (n = 33), stade III and IV (n = 53). Sixty patients underwent pelvic and paraaortic lymphadenectomy with separate study of the different groups of nodes. RESULTS: There was a lymph node involvement in 48.8% of all cases and in 36% of stade I and II carcinomas. Lymph node involvement was observed for all histological types. It was present in both pelvic and paraaortic nodes in 52.3% of the patients N+. Its incidence was 46.1% in patients before chemotherapy and 52.9% in patients after chemotherapy. It may concern all anatomical location with a 5 to 31% frequency. There was no postoperative death and a low morbidity rate (13.9%). CONCLUSIONS: Retroperitoneal lymphadenectomy is feasible; it is a contribution to the tumoral cytoreduction and to a better classification of ovarian carcinomas. According to this series and to the other reported series, an initial, complete, pelvic and paraaortic lymphadenectomy should be recommended for all cases of ovarian carcinomas but prospective randomised trials are necessary to appreciate the impact of this lymphadenectomy on survival.

[Lymph node mapping and axillary sentinel lymph node biopsy in 243 invasive breast cancers with no palpable nodes. The south Lyon hospital center experience]. / Le marquage lymphatique et la biopsie du ganglion sentinelle axillaire dans 243 cancers invasifs du sein sans ganglion palpable. Expérience du centre hospitalier Lyon-Sud.

STUDY AIM: To evaluate the effect of intraoperative lymph node mapping and sentinel lymph node dissection (SLND) on the axillary staging of patients with N0 breast carcinoma. Two techniques were used: blue dye alone (Evans Blue and Patent Blue) and combined technique (blue dye and isotope). METHODS: The incidence of axillary node metastasis in axillary lymph node dissection (ALND) and SLND was compared prospectively. Multiple sections of each SLN were examined by HPS staining and immunohistochemical techniques. Two sections of each non sentinel node in ALND specimens were examined by routine HPS staining. RESULTS: 243 patients underwent ALND after SLN biopsy. The SLN detection rate was 225/243 cases (92.59%): 89.94% with blue dye alone and 100% with the combined technique. The false-negative rate was less than 2%. CONCLUSION: SN biopsy is an accurate staging technique for N0 breast cancer. SLN biopsy with multiple sections and immunohistochemical staining of the SLN can identify significantly more patients with lymph node metastases than ALND with routine HPS staining.

Tagging sentinel lymph nodes: a study of 100 patients with breast cancer.

The aim of this study was to evaluate in breast cancer patients the feasibility of sentinel lymph node (SLN) identification and the sensitivity of this technique to detect node metastases. Between January and July 1997, SLNs were tracked with Evans Blue dye in 100 patients with breast cancer who then underwent complete level I/II axillary lymph node dissection (ALND). All SLNs were examined by haematoxylin-phloxin-saffron (HPS) staining and immunohistochemistry (IHC) of multiple sections. The findings for the SLNs were compared with results on ANLD. Axillary SLNs were identified in 83 patients (detection rate = 83%; 95% confidence interval (CI) 74-90%). Axillary SLNs were detected in 58/83 cases (70%) at level I only, and in 69/83 (83%) at levels including level I. Histologically positive axillary SLNs were found in 45% (37/83) of patients, including 2 patients with malignancy (micro-metastases) detected by IHC only. The sensitivity of axillary SLN to detect axillary lymph nodes metastases was 37/39 = 95% (95% CI 83-99%). SLNs of the internal mammary chain (IMC) were dissected for 33 tumours of the median or inner quadrants and detected in 26/33 = 79% of cases (95% CI 61-91%). In our experience, the overall sensitivity of SLN identification as a predictor of node (axillary or IMC) metastases was 41/43 = 95% (95% CI 84-99%), confirming the usefulness of the procedure.

Primary squamous cell carcinoma in a patient with vaginal agenesis.

BACKGROUND: The development of a carcinoma in a neovagina constructed in patients with congenital vaginal agenesis is rare. CASE: To our knowledge, this is the first report of a squamous cell carcinoma developing in a neovagina that had been constructed by a simple cleavage technique without tissue transplantation. The latency period between reconstruction and tumor diagnosis was 20 years, during which the patient regularly used a prosthesis. The most important observation during this time was the repeated formation of granulation tissue and chronic inflammatory pseudopolyps in the neovagina, which were removed by cauterization. Despite pre- and intraoperative irradiation and radical surgery followed by chemotherapy, the prognosis is poor. CONCLUSION: Patients with neovaginas, whatever the construction technique, need to be followed up regularly, as mechanical irritation from a prosthesis can add to other cancer risk factors, such as viral infection. Furthermore, the absence of transplanted tissue does not seem to protect from the risk.

[Unresolved questions in the indications for the conservative treatment of invasive cancer of the breast]. / Questions non résolues dans les indications du traitement conservateur du cancer invasif du sein.

The majority of patients with breast cancer can be treated by partial mastectomy and radiation therapy. The choice of the treatment involves the estimation of the risk for intramammary recurrence and the ability to achieve satisfactory cosmetic result. Patient selection in breast conserving therapy is dependent on clinical and histologic characteristics of the tumor, but many times the therapeutic decision is not easy. We present a review of the literature in order to try to resolve some controversed questions about breast conservation in relation to tumor size, margin status, tumor location, multicentricity, histologic subtype or presence of extensive intraductal component, age of patients and genetic factors.

Unsolved questions about conservative treatment of infiltrating breast carcinoma

The majority of patients with breast cancer can be treated by partial mastectomy and radiation therapy. The choice of the treatment involves the estimation of the risk for intramammary recurrence and the ability to achieve satisfactory cosmetic result. Patient selection in breast conserving therapy is dependent on clinical and histologic characteristics of the tumor, but many times the therapeutic decision is not easy. We present a review of the literature in order to try to resolve some contreversed questions about breast conservation in relation to tumor size, margin status, tumor location, multicentricity, histologic subtype or presence of extensive intraductal component, age of patients and genetic factors.