About this Research Topic
Primary systemic medical therapy (PST) in breast cancer is aimed to increase resectability of locally advanced breast cancer and inflammatory breast cancer (stage IIIA-IIIC), and enables early administration of systemic therapy to individuals at highest risk of systemic occult disease; increase the feasibility of breast conserving surgery among women with Stage II-III invasive breast cancer, who would otherwise require mastectomy due to unfavorable breast-to-tumor ratio; decrease the morbidity and extent of axillary surgery in women with significant axillary nodal disease; downstage the axilla in node positive patients who might benefit from sentinel node biopsy. The crucial point in the post-therapy evaluation of patients from a surgical point of view consists of establishing, in the best way, the extent of the residual tumor in order to understand the most appropriate and effective surgical procedure to obtain tumor-free surgical margins.
Decision for surgery is usually made 3-6 weeks after the end of neoadjuvant therapy, and the choice of the surgical procedure depends on the extent of the disease at presentation, tumor response to therapy, genetic testing, and the need of radiotherapy after surgery.
Magnetic resonance imaging (MRI) and contrast enhanced mammography (CESM) are superior to clinical breast examination, standard mammography, and ultrasound for assessing the extent of residual breast disease after PST, whereas axillary ultrasound is superior to MRI and PET/CT for detection of residual axillary disease. The extent of microcalcifications impacts eligibility for breast conserving surgery, but correlates poorly with the extent of residual disease. Patients with non-palpable disease following PST should undergo a localization procedure of the residual lesion or tissue marker.
The main objective for the surgeon is to establish the correct surgical procedure in relation to the residual tumor identified through the most suitable instrumental tests.
The purpose of this research topic is to:
1. Define the most suitable instrumental procedure to detect the residual disease after neoadjuvant therapy, also possibly 3D instrumental procedures;
2. Establish selection criteria to nominate patients for conservative or demolition surgeries;
3. Understand if subcutaneous mastectomy interventions are the most indicated in these categories of patients compared to conservative surgery, and if so, in which cases.
Through meta-analyzes, original researches, case reports, and reviews, we will try to trace a common line of thought that can guide the surgeon in the best therapeutic choice in the treatment of breast cancer patients after medical therapies.
Decision for surgery is usually made 3-6 weeks after the end of neoadjuvant therapy, and the choice of the surgical procedure depends on the extent of the disease at presentation, tumor response to therapy, genetic testing, and the need of radiotherapy after surgery.
Magnetic resonance imaging (MRI) and contrast enhanced mammography (CESM) are superior to clinical breast examination, standard mammography, and ultrasound for assessing the extent of residual breast disease after PST, whereas axillary ultrasound is superior to MRI and PET/CT for detection of residual axillary disease. The extent of microcalcifications impacts eligibility for breast conserving surgery, but correlates poorly with the extent of residual disease. Patients with non-palpable disease following PST should undergo a localization procedure of the residual lesion or tissue marker.
The main objective for the surgeon is to establish the correct surgical procedure in relation to the residual tumor identified through the most suitable instrumental tests.
The purpose of this research topic is to:
1. Define the most suitable instrumental procedure to detect the residual disease after neoadjuvant therapy, also possibly 3D instrumental procedures;
2. Establish selection criteria to nominate patients for conservative or demolition surgeries;
3. Understand if subcutaneous mastectomy interventions are the most indicated in these categories of patients compared to conservative surgery, and if so, in which cases.
Through meta-analyzes, original researches, case reports, and reviews, we will try to trace a common line of thought that can guide the surgeon in the best therapeutic choice in the treatment of breast cancer patients after medical therapies.
Keywords: Breast Cancer, Surgical Treatment, Neoadjuvant Medical Therapy, PST, Residual Disease Detection
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