A pathological complete response after neoadjuvant combination chemotherapy in breast cancer patients

Objective. To study the effect of a pathological complete response (pCR) of the tumor after neoadjuvant combination chemotherapy (NACCT) on 3-and 5-year relapse-free and overall survival rates in breast cancer (BC) patients. Subjects and methods. The authors analyzed the 2013—2020 medical records of 200 patients with Stage II—III BC (Stage IIIB was ruled out), who underwent organ-sparing surgeries and radical mastectomies at the second stage of combination treatment after NACCT at the Department of Breast and Skin Cancer and Reconstructive and Plastic Surgery, P.A. Herzen Moscow Oncology Research Institute. The distribution of BC stages was as follows: Stage I was diagnosed in 5 (2.5%) patients; Stage II in 113 (56.5%), and Stage III in 82 (41%) (Stage IIIB was ruled out). Results. A pCR was achieved in 37 (18.5%) patients; a pathological partial response was in 163 (81.5%). The pCR was most com-monly achieved in patients with invasive non-specific BC (90.5%). In the 37 patients, the pCR was achieved in patients with tri-ple-negative BC (37.5%), Her2/neu-positive BC (30%), Her2/neu-positive luminal B BC (17.5%), and Her2/neu-negative luminal B BC (15%); pCR was most frequently observed in high-grade (G3) BC (57.5%) and in moderate-grade (G2) BC (42.5%). The 5-year relapse-free and overall survival rates were 100%. One patient was noted to have progressive disease as lung metastasis at 22 months after surgical treatment. Conclusion. The investigation has established a correlation between the degree of a pathological tumor response in BC patients after NACCT and the rates of 3-and 5-year disease-free and overall survival. The predictive value of pCR is in direct proportion to the IHC-defined type of BC, which is more often detected in its aggressive morphological variants: her2/neu-positive (47.5%) and triple-negative (37.5%). © 2022, Media Sphera Publishing Group. All rights reserved

Complications after simultaneous prepectoral breast reconstruction using polyurethane-coated implants in patients with breast cancer

Background. The development and improvement of reconstructive breast surgery provides medical, psychological and social rehabilitation of cancer patients, allowing them to achieve the best cosmetic and functional results. The trend towards the return of prepectoral reconstruction is associated not only with the improvement of mastectomy techniques, but also with implant coating and the emergence of highly cohesive silicone gel filling of implants. The use of polyurethane-coated endoprostheses in prepectoral reconstruction provides more reliable fixation to the surrounding tissues and allows reconstruction of the mammary glands without additional covering of the endoprosthesis. Objective: To improve the results of surgical treatment when performing a one-stage reconstruction by pre-rectal placement of polyurethane-coated implants in breast cancer. Materials and methods. In the period from April 2017 to September 2020 at the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin of P.A. Herzen Moscow Oncology Research Institute performed 340 prepectoral breast reconstructions (direct-to-implant) using polyurethane-coated implants in breast cancer patients. A group of patients was analyzed (n = 208). Results. We noted the following complications: Prolonged seroma (more than 30 days) in 39 (18.6 %) patients, red breast syndrome in 31 (14.8 %) patients, capsular contracture III-IV degree by J.L. Baker in 43 (20.57 %) patients, protrusion/extrusion of the endoprosthesis in 23 (11 %) patients, suture divergence in 8 (3.8 %) patients, necrosis in 8 (3.8 %) patients, infectious complications in 14 (6.7 %) patients, ripping in 10 (4.8 %) patients. Also, 2 (0.95 %) patients had a violation of the integrity of the endoprosthesis, and 2 (0.95 %) patients had rotation of the endoprosthesis. Conclusions. Prepectoral breast reconstruction can be used as an alternative to subpectoral reconstruction in primary operable forms of breast cancer with sufficient thickness of integumentary tissues. © 2020 ABC-press Publishing House. All right reserved