Neoadjuvant combined with radiotherapy double-fisted, some early breast cancer has been cured.

In the treatment of tumors, surgical resection is the preferred and effective method for most solid tumors, and usually only tumors that are diagnosed at an early stage and have not metastasized have the opportunity to
be surgically removed.
Therefore, patients who can be treated surgically often want to completely remove the tumor lesion or diseased organ, leaving no chance for
the tumor to recur.
However, any organ in the human body, whether partially or completely removed, will have a certain impact
.
For example, breast cancer surgery not only brings harm to the patient's body, but also has an indescribable impact on the
psyche.

However, almost no patient will choose not to undergo surgery because of concerns about postoperative physical disability, which is forced and helpless
.
Recently, a phase II clinical trial of The Lancet Tumor gave a conclusion that for some breast cancers that achieve complete pathological remission with neoadjuvant therapy, moderate radiotherapy can achieve very good results
without surgery.

Fig.
Source Pexels

Neoadjuvant chemotherapy for breast cancer

According to the expression of hormone receptors and HER2 proteins, breast cancer is divided into hormone receptor-positive breast cancer, HER2 positive breast cancer and triple negative breast cancer
.

For early-stage breast cancer, if the tumor is small, and there is only one or no nearby lymph node metastases, and no distant organ metastases, neoadjuvant chemotherapy is used, and with neoadjuvant chemotherapy, complete remission
is achieved in 60% to 80% of triple-negative breast cancers and HER2-positive breast cancers.

This complete remission does not mean that the tumor lesion is completely undetectable, but there may be a small lesion, but after percutaneous image-guided vacuum-assisted core biopsy (VACB), it is determined that the lesion is free of invasive cancer cells
.
This method of puncture biopsy requires sampling at multiple sites of the tumor lesion to finally verify that the tumor lesion is indeed not invasive
.

When the tumor lesion shrinks after neoadjuvant chemotherapy and there is no residual cancer cell after the puncture biopsy, is it not necessary to surgically remove the breast and lymph nodes, but through moderate radiotherapy, a better treatment effect can be obtained? The following clinical trial gives the corresponding conclusions
.

Neoadjuvant therapy has saved some patients with early-stage breast cancer from surgery

This is a multicenter, single-arm Phase II clinical trial conducted at 7 centers in the United States, requiring patients over the age of 40 years with at most one lymph node metastasis and no distant organ metastases, and are classified as triple-negative breast cancer or HER2-positive breast cancer
.

From March 6, 2017 to November 9, 2021, a total of 58 patients were enrolled in this clinical trial
.
Among them, 4 patients had lesions that were too large after imaging examination, and the other 4 patients chose surgery, and a total of 50 patients actually entered the study
.

The median age of the patients was 62 years, the average tumor size at the time of enrollment was 2.
28 cm, and 9 patients had lymph node metastases
.
58% of patients had HER2-positive breast cancer and another 42% had triple-negative breast cancer
.
The average tumor lesion after neoadjuvant therapy was 0.
9 cm, and 34% of patients had no visible tumor lesions
.

After neoadjuvant therapy, enrolled patients underwent a needle biopsy
of the residual lesion.
Stereotactic-guided breast biopsy was performed in 86% of patients and ultrasound-guided needle biopsy
was performed in 14% of patients.
Among them, 19 patients had residual lesions and 31 patients had no residual lesions, achieving complete remission
.

Patients who do not find residual lesions do not undergo surgery, and patients receive standard whole-breast radiotherapy (15 doses of 40 Gy or 25 doses of 50 Gy), plus the next seven doses of 14 Gy supplemental radiation therapy
.

Fig.
Breast cancer subtype, neoadjuvant response to therapy

As shown above, 31 patients who achieved complete remission with neoadjuvant therapy did not experience recurrence of ipsilateral breast tumors, no related serious adverse events, and no treatment-related deaths
during a median follow-up of 26.
4 months.

revelation

Up to now, the follow-up of this study has been carried out for nearly two years, and after neoadjuvant therapy, breast cancer patients whose lesions have completely disappeared or have no residual living cells, only using standard radiotherapy in the later stage, have achieved a good treatment effect, and there is no local or distant recurrence
of the disease.
These data are very important because if residual cancer cells are present, with only neoadjuvant therapy, patients with triple-negative breast cancer or HER2-positive breast cancer tend to relapse
within a few years.

This study was published in the international top academic journal "Lancet Tumor", and the results of this phase II clinical trial are enough to give us confidence
.
More patients will be included in the study at a later stage, and a prospective phase III clinical trial will confirm the patient benefit of
these treatments.

In addition, the degree of cancer reminds everyone to pay attention to the breast cancer subtypes in the study, and the way
to perform a needle biopsy at the end.
In the study, 12 needles were punctured (sampling of 12 locations was done at one time)
for the lesion.
After a relatively comprehensive test, it is confirmed that there is no invasion of residual tumor cells, and standard radiotherapy
is selected.
This is a special concern for patients who wish to refer to the above studies and do not undergo surgery at a later stage
.

Welcome everyone to pay attention to the degree of cancer, join the cancer degree patient group, and exchange treatment and recovery information
with each other.

References:

Henry M Kuerer, et al.
, Eliminating breast surgery for invasive breast cancer in exceptional responders to neoadjuvant systemic therapy: a multicentre, single-arm, phase 2 trial, Lancet Oncol， 2022

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