Feasibility of Breast Conserving Surgery in Stage IIIA Breast Carcinoma Patients in the Absence of Neoadjuvant Therapy

Background: Preoperative determination of the extent of viable residual tumor is an important issue after neoadjuvant treatment. On the other hand, retrospective data suggest that breast-conserving surgery is feasible up to stage IIIA breast cancer without preoperative therapy. Methods: We retrospectively analyzed 164 patients who underwent breastconserving surgery followed by adjuvant chemotherapy and/or endocrinal therapy with whole breast radiation between 2005 and 2012. Of those, 116 patients had stages I and II (group 1) breast cancer, whereas 48 patients had stage IIIA (group 2). Results:After a median follow-up of 40.4 months, 18 (15.5%) patients in group- 1and 8 (16.6%) in group-2 developed ipsilateral breast tumor recurrence (P=0.77). Mean time to tumor recurrence was 19 months in group 1 and 17 months in group 2 (P=0.5). However we found more ipsilateral breast tumor recurrence in hormone negative tumors (P=0.002), high grade tumors (P=0.021), young age (P=0.017) and lymph node positive cases (P=0.011). We observed no significant difference between N1 and N2 lymph node status (P=0.241). Conclusion: Our data suggest that breast-conserving surgery with R0 resection is feasible in stage IIIA cases whenever cosmetic appearance can be maintained as long as surgery will be followed by radiotherapy and chemotherapy. A prospective study with larger numbers is recommended for further evaluation of this issue.