National Surgical Adjuvant Bowel and Breast Project B-18

• The National Surgical Adjuvant Bowel and Breast Project B-18 was designed to:
  • Determine whether preoperative chemotherapy would result in improved survival compared to postoperative chemotherapy.
  • Secondary aims included:
    • Evaluation of pCR rates
    • Comparison of:
      • Breast conservation rates between the two groups
      • Ipsilateral recurrence rates between the two groups.
• Between 1988 and 1993:
  • 1523 patients with clinical T1 to T3, N0 to N1 operable breast cancer were enrolled in the trial:
    • 763 were randomized to preoperative therapy while 760 were randomized to postoperative therapy.
  • At 16 years of follow-up:
    • There was no difference in disease-free survival (HR = 0.93, 95% CI, 0.81 to 1.06, p = 0.27) or overall survival (HR = 0.99, 95% CI, 0.85 to 1.16, p = 0.90) between the postoperative and preoperative chemotherapy groups.

 

• In the preoperative group:
  • A pCR was documented in 13% of patients.
  • Preoperative chemotherapy patients had a significantly increased incidence of having pathologically negative nodes compared to postoperative chemotherapy patients:
    • 58% vs. 42%, respectively; p<0.0001.
  • The rate of breast conservation was higher among women who received neoadjuvant chemotherapy compared to women who received postoperative chemotherapy:
    • 68% versus 60%, respectively; p = 0.001:
      • The significant downstaging of tumors greater than 5 cm in the preoperative chemotherapy arm primarily drove this breast conservation trend.
  • There was a trend toward a higher rate of ipsilateral breast tumor recurrence with preoperative vs postoperative chemotherapy:
    • 13% of 506 patients vs 10% of 450 patients, respectively, although this difference was not statistically significant (p = 0.21).
• Retrospective series later found:
  • No difference in surgical complications between women who received preoperative or postoperative chemotherapy.

 

Rodrigo Arrangoiz MS, MD, FACS a surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

• He is an expert in the management of breast cancer.

  • If you have any questions about the screening for breast cancer please fill free to contact Dr. Arrangoiz.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com