• Antonino Grassadonia, Marta Di Nicola, Simona Grossi, Paolo Noccioli, Saveria Tavoletta, Roberto Politi, Domenico Angelucci, Camilla Marinelli, Marinella Zilli, Giampiero Ausili Cefaro, Nicola Tinari, Michele De Tursi, Laura Iezzi, Pasquale Cioffi, Stefano Iacobelli, Clara Natoli, and Ettore Cianchetti.
• Medical Oncology Unit, Department of Experimental and Clinical Sciences, University 'G. d'Annunzio', Chieti, Italy.
• Ann. Surg. Oncol. 2014 May 1; 21 (5): 1575-82.

BackgroundAromatase inhibitors (AIs) are more effective than tamoxifen as neoadjuvant endocrine therapy (NET) for hormone receptor (HR)-positive breast cancer. Here we report the surgical and long-term outcome of elderly postmenopausal patients with locally advanced, HR-positive breast cancer treated with preoperative AIs.MethodsBetween January 2003 and December 2012, 144 postmenopausal patients inoperable with breast conservative surgery (BCS) received letrozole, anastrozole, or exemestane as NET. Patients underwent breast surgery and received adjuvant AIs. Adjuvant systemic therapy, chemotherapy and/or trastuzumab, and adjuvant radiotherapy were administered as appropriate, but limited to high-risk patients with few or no comorbidities.ResultsAfter a median follow-up of 49 months, 4 (3.0 %) patients had local relapse, 18 (12.5 %) had distant metastases, and 24 (17.0 %) died. BCS was performed in 121 (84.0 %) patients. A tumor size <3 cm and human epidermal growth factor receptor 2 (HER2) negativity were predictors of BCS. The achievement of BCS and grade G1 were significantly associated with longer disease-free survival (DFS) (p = 0.009 and p = 0.01, respectively) and overall survival (p = 0.002 and p = 0.005, respectively). Residual tumor ≤2 cm (yT0-yT1) in the longest diameter after NET was also statistically associated with longer DFS (p = 0.005).ConclusionsThe results of this retrospective study indicate that elderly breast cancer patients with a tumor size <3 cm at diagnosis and HER2 negativity have a higher probability of achieving BCS after NET. Moreover, patients treated with BCS and with grade G1 tumor have a reduced risk of recurrence and death in the long-term follow-up.

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