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Multidisciplinary surgery planning of triple negative non metastatic breast cancers.


Multidisciplinary surgery planning of triple negative non metastatic breast cancers.

Guendouz – M. Brahimi – L. Rahal. Breast Surgery Unit , Department of Surgery  Djillali Rahmouni Hospital. Algiers. 

Triple negative breast cancer (TNBC) accounts for approximately 10–20% of breast cancers (1). The main treatment armamentarium for non metastatic TNBC includes surgery, systemic therapy, and radiotherapy (2). Due to the lack of expression of ER, PR and HER-2, endocrine therapy and anti-HER-2 targeted therapy for TNBC patients are ineffective, chemotherapy is the main method of systemic treatment (1).

The TNBC is often characterized by younger age, a higher probability of “interval” breast cancer, (3) and significantly shorter median survival and disease-free survival than other breast cancer subtypes (4). BRCA1 associated breast cancers with the TNBC phenotype are apparently significant (5).

This phenotype is known to affect negatively local-regional recurrence (LRR) rates during the first 3 years following the treatment (3).

Therefore, the paucity of therapeutic options imposes the optimization of the current locoregional management of patients with TNBC and reduce the risk of locoregional recurrences (6).

Due to the high risk of LRR in TNBC, wide surgery would be reasonable, however study results are conflicting. While some studies show that total mastectomy increases the locoregional recurrence risk, others studies have found no difference with patients that underwent BCS (2). Therefore, standards of care for surgical treatment between TN and other phenotypes do not differ (7).

Furthermore, patients with TNBC who obtain a pCR have superior event-free and overall survival compared with patients with residual invasive disease after the same treatment. At least one-third of patients with stages II and III TNBC achieve a pCR after neoadjuvant chemotherapy As such, at the recent St Gallen consensus conference, NST(neoadjuvant systemic treatment) was deemed the preferred treatment option for patients with TNBC irrespective of tumor diameter and axillary nodal involvement (8).

Early-stage TNBC treated with BCS were shown to have lower 5-year LR(local recurence) rates and similar OS (overall survival) than the mastectomy group. Based on this, the researchers believe that TNBC should not be a contraindication to breast-conserving therapy (1). The mortality rate is declining due to the application of multidisciplinary approaches and the management of breast cancer with effective individualized treatments (9).

The purpose of this presentation is to report the planning of the surgical treatment of TNBC within a multidisciplinary meeting.


1- Leqian Guo. Local treatment for triple-negative breast cancer patients undergoing chemotherapy: breast-conserving surgery or total mastectomy? BMC Cancer (2021) 21:717 https://doi.org/10.1186/s12885-021-08429-9.

2- Gabriel De-la-Cruz-Ku. Breast-conserving surgery vs. total mastectomy in patients with triple negative breast cancer in early stages: a propensity score analysis. Breast Disease 1 (2019) 1–7.

3- Jacques Bernier. Surgery and radiation therapy of triple-negative breast cancers: From biology to clinics. The Breast 28 (2016) 148-155.

4- Huan Li. T1-2N0M0 Triple-Negative Breast Cancer Treated With Breast-Conserving Therapy Has Better Survival Compared to Mastectomy. Clinical Breast Cancer Month 2019.

5- Ahmet Cinkaya. Evaluation of treatment outcomes of breast cancer.  Journal of Cancer Research and Therapeutics – January-March 2016 – Volume 12 – Issue 1.

6- Bassam S. Abdulkarim. Increased Risk of Locoregional Recurrence for Women With T1-2N0 Triple-Negative Breast Cancer Treated With Modified Radical Mastectomy Without Adjuvant Radiation Therapy Compared With Breast-Conserving Therapy. Journal of clinical oncology volume 29,  number 21,  july 20 2011.

7- Alina M. Mateo. Time to Surgery and the Impact of Delay in the Non-Neoadjuvant Setting on Triple Negative Breast Cancers and Other Phenotypes. Ann Surg Oncol. 2020 May ; 27(5): 1679–1692. 

8- Mehra Golshan. Breast Conservation After Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer. JAMA Surg. doi:10.1001/jamasurg.2019.5410 Published online January 8, 2020.

9- Qing-Xia Chen. The different outcomes between breast-conserving surgery and mastectomy in triple-negative breast cancer. Oncotarget, 2017,Vol. 8, (No. 3), pp: 4773-4780.

  • October 20, 2023