Goldberg H, Zandbank J, Kent V, Leonov-Polak M, Livoff A, Chernihovsky A, Guindy M, Evron E
Galilee Medical Center, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Surg Oncol. 2017 Aug;43(8):1415-1420. doi: 10.1016/j.ejso.2017.04.011. Epub 2017 May 4.
We studied the effect of neoadjuvant chemotherapy (NAC) ± trastuzumab on the ductal carcinoma in situ (DCIS) component in patients with locally advanced breast cancer who achieved pathological complete response (pCR).
The diagnostic biopsies of 92 consecutive breast cancer patients that were treated with neoadjuvant chemotherapy (NAC) ± trastuzumab were evaluated for the presence of DCIS. Upon completion of NAC, the surgical specimens were evaluated for complete eradication of both the invasive and non-invasive cancer in the breast. The pretreatment mammograms were evaluated for the presence of microcalcifications and compared to the mammograms that were obtained upon completion of therapy prior to surgery.
Thirty of 92 patients (33%) had a substantial component of DCIS in the pretreatment biopsy. Thirty nine patients (42%) achieved pCR: 22 (56%) following NAC + trastuzumab, 17 (32%) following chemotherapy only. Ten of 30 patients (33%) with DCIS component achieved pCR: 4 received chemotherapy only, in 6 trastuzumab was added. Multiple microcalcifications on the pretreatment mammograms were observed in 3 of 10 patients with DCIS who achieved pCR. No reduction in the area of calcifications was observed following NAC.
DCIS may be completely eradicated by NAC ± trastuzumab. However, associated microcalcifications probably persist. Patients with locally advanced breast cancer with substantial DCIS may still opt for NAC and breast conservation as the DCIS component may respond and even completely disappear following NAC. Residual widespread microcalcifications after NAC do not necessarily indicate residual cancer. Larger studies are needed to direct the surgical management of these patients.
我们研究了新辅助化疗（NAC）±曲妥珠单抗对局部晚期乳腺癌患者达到病理完全缓解（pCR）时导管原位癌（DCIS）成分的影响。
对92例接受新辅助化疗（NAC）±曲妥珠单抗治疗的连续乳腺癌患者的诊断性活检标本进行DCIS评估。NAC完成后，对手术标本进行评估，以确定乳腺浸润性癌和非浸润性癌是否完全根除。对治疗前的乳房X线照片进行微钙化评估，并与手术前治疗完成后获得的乳房X线照片进行比较。
92例患者中有30例（33%）在治疗前活检中有大量DCIS成分。39例患者（42%）达到pCR：NAC + 曲妥珠单抗治疗后22例（56%），单纯化疗后17例（32%）。30例有DCIS成分的患者中有10例（33%）达到pCR：4例仅接受化疗，6例加用曲妥珠单抗。10例达到pCR的DCIS患者中有3例在治疗前乳房X线照片上观察到多处微钙化。NAC后钙化面积未见缩小。
NAC±曲妥珠单抗可能完全根除DCIS。然而，相关的微钙化可能持续存在。局部晚期乳腺癌伴大量DCIS的患者仍可选择NAC和保乳手术，因为DCIS成分可能对NAC有反应甚至完全消失。NAC后残留广泛微钙化不一定表明有残留癌。需要更大规模的研究来指导这些患者的手术管理。
