ROLL after neo adjuvant treatment

Published Date: 19th July 2016

Publication Authors: Jois RHS, Harris O,

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Neo-adjuvant chemo & hormone therapy is very effective in reducing the size of the primary breast cancer: this may result into a substantial response, hence the need to localise a non-palpable lesion. A variety of localisation techniques are used to target surgical removal of these subclinical lesions i.e., Wire marker, Skin tattoo, USG Skin marking, 125 I seed localization. An online search showed lack of literature on the use of ROLL in this setting.

Aim

Testing feasibility and usefulness of a modified ROLL technique in the management of locally advanced breast cancers treated with primary systemic therapy.

Materials and methods

Modified ROLL has been used at our institute since 2002 to target non palpable breast lesions. This series analyses the use ROLL on locally advanced breast cancer patients who received neo-adjuvant chemo/ hormone therapy. The tumour size is measured with mammogram, ultrasound and/or MRI before neo-adjuvant therapy. The response rate is assessed the same imaging. A radio- opaque coil is inserted to mark the tumour bed at the commencement of neo-adjuvant therapy. Patients whose primary tumour has subsequently become non palpable are assessed for suitable image guidance i.e. USG or stereo guidance to localise.

Results

60 patients underwent neo-adjuvant therapy for locally advanced cancer Dec 2007 to Dec 2012, with 41/60 lesion becoming non-palpable. Median age: 49 (IQR: 27 - 90 years). A mass was the most frequently observed mammographic feature (24/41; 56%). The median size of the tumour was 32mm (pre neo-adjuvant) and 16mm after neo-adjuvant. 40 lesions (97%) were localised with US. ROLL along with SLNB was performed for 14/41 (35%). 40 lesions were invasive ductal carcinomas. The observed tumour biology was: poorly differentiated tumour 21/41 (51%); ER negative 17/41 (41%); Her2 negative 10/ 41 (24%); LVI positive 8/41 (19%); Node positive 17/37 (46%). Median specimen weight: 52 gm. 36 (87%) lesions was removed within unaffected margins (> 1mm clearance) and or negative cavity shavings. 5 patients (12%) underwent redo-surgery. 2 local (4.9%) and 7 systemic (17%) recurrences were observed after a 39 months median follow-up.

Conclusions

ROLL is not only feasible after neo-adjuvant therapy for breast cancer but highly successful with no failures observed in our series. Observed cancer recurrence (LR & SR) seems to be related to the aggressive tumour biology than to do with ROLL technique.

Jois, R; Harris, O; Audisio, RA. (2014).  ROLL after neo-adjuvant treatment . European Journal of Surgical Oncology. 40 (11), S86-87

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