{"doi":"10.17615/3qn5-sn85","title":"Impact of neoadjuvant therapy on eligibility for and frequency of breast conservation in stage II–III HER2-positive breast cancer: surgical results of CALGB 40601 (Alliance)","abstract":"It had been previously shown that patients who receive neoadjuvant systemic therapy (NST) are more likely to undergo breast-conserving therapy (BCT) than those who have primary surgery. However, the frequency with which patients who are not BCT-eligible prior to NST convert to BCT-eligible with treatment is unknown. To document this conversion rate in a subset of patients expected to have a high clinical response rate to NST, we studied surgical assessment and management of patients enrolled on a randomized neoadjuvant trial for stage II-III HER2-positive breast cancer (HER2 + BC)(CALGB 40601). The treating surgeon assessed BCT candidacy based on clinico-radiographic criteria both before and after NST. Definitive breast surgical management was at surgeon and patient discretion. We sought to determine (1) the conversion rate from BCT-ineligible to BCT-eligible (2) the percentage of BCT-eligible patients who chose breast conservation, and (3) the rate of successful BCT. We also evaluated surgeon-determined factors for BCT-ineligibility and the correlation between BCT eligibility and pathologic complete response (pCR). Of 292 patients with pre- and post-NST surgical assessments, 59 % were non-BCT candidates at baseline. Of the 43 % of these patients who converted with NST, 67 % opted for BCT, with an 80 % success rate. NST increased the BCT-eligible rate from 41 to 64 %. Common factors cited for BCT-ineligibility prior to NST including tumor size (56 %) and probable poor cosmetic outcome (26 %) were reduced by 67 and 75 %, respectively, with treatment, while multicentricity, the second most common factor (33 %), fell by only 16 %. Since 23 % of the BCT-eligible patients chose mastectomy, BCT was the final surgical procedure in just 40 % of the patients. Patients considered BCT-eligible both at baseline and after NST had a pCR rate of 55 %, while patients who were BCT-ineligible prior to NST had the same pCR rate (44 %) whether they converted to BCT-eligible or not. Many patients with HER2 + BC deemed ineligible for BCT at baseline can be converted to BCT-eligible with NST; excluding patients with multicentric disease substantially increases that percentage. In converted patients who opt for BCT, the success rate is similar to that of patients considered BCT-eligible at baseline. Whether a BCT-ineligible patient converts to BCT eligibility or not does not appear to affect the likelihood of achieving a pCR. Despite the efficacy of NST in this patient cohort, only 40 % of patients had successful BCT; further research into why BCT-eligible patients often opt for mastectomy is needed.","journal":"UNC Libraries","year":2020,"id":136895,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.958,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":249118,"name":"Lisa A. Carey","orcid":"0000-0003-2388-4649","position":1,"is_corresponding":false},{"id":352710,"name":"Beth Overmoyer","orcid":"0000-0003-4438-7000","position":2,"is_corresponding":false},{"id":396232,"name":"Constance Cirrincione","orcid":null,"position":3,"is_corresponding":false},{"id":394927,"name":"William M. Sikov","orcid":"0000-0001-5451-6449","position":4,"is_corresponding":false},{"id":396231,"name":"Mehra Golshan","orcid":null,"position":5,"is_corresponding":false},{"id":596713,"name":"Nora L. Henry","orcid":null,"position":6,"is_corresponding":false},{"id":596714,"name":"for the Alliance for Clinical Trials in Oncology","orcid":null,"position":7,"is_corresponding":false},{"id":332489,"name":"Clifford A. Hudis","orcid":"0000-0001-7144-8791","position":8,"is_corresponding":false},{"id":3752,"name":"Eric P. Winer","orcid":"0000-0002-8819-1723","position":9,"is_corresponding":false},{"id":374168,"name":"David W. Ollila","orcid":"0000-0003-4129-6808","position":10,"is_corresponding":false},{"id":316454,"name":"Elisa Port","orcid":"0000-0002-6557-5660","position":11,"is_corresponding":false},{"id":230995,"name":"Donald A. Berry","orcid":"0000-0002-7657-3871","position":12,"is_corresponding":false},{"id":375057,"name":"George Somlo","orcid":null,"position":13,"is_corresponding":false},{"id":332500,"name":"Harold J. Burstein","orcid":"0000-0003-1963-8162","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-18T23:16:52.487376Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}