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Introduction Breast cancer is a heterogeneous disease stratified into several molecular subtypes with different behavior and prognosis. 1 , 2 In clinical setting, breast cancer is routinely classified into approximated subtypes using immunohistochemistry according to hormone receptor (HR) and human epidermal growth factor 2 receptor (HER2) status. Primary systemic therapy (PST) is the standard of care for locally advanced breast cancer, and it is increasingly being used for early breast cancer to improve cosmetic outcome after breast-conserving surgery (BCS

://dx.doi.org/10.1200/JCO.2005.02.6187 [3] Bonadonna G, Veronesi U, Brambilla C, Ferrari L, Luini A, Greco M et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst, 1990, 82, 1539–1545 http://dx.doi.org/10.1093/jnci/82.19.1539 [4] Kulka J, Tokes AM, Toth AI, Szasz AM, Farkas A, Borka K et al. [Immunohistochemical phenotype of breast carcinomas predicts the effectiveness of primary systemic therapy]. Magy Onkol, 2009, 53, 335–343 http://dx.doi.org/10.1556/MOnkol.53.2009.4.2 [5] Fisher B, Bryant J, Wolmark N

, et al. Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors. J Clin Oncol 2006; 24: 1037-44. 5. Gianni L, Baselga J, Eiermann W, Guillem Porta V, Semiglazov V, Lluch A, et al. Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European cooperative trial in operable breast cancer. J Clin Oncol 2009; 27: 2474-81. 6. Wolmark N, Wang J, Mamounas E, Bryant J

, Verbanac KM, Lannin DR. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer. Am J Surg. 2001; 182:312-5. 10.1016/S0002-9610(01)00718-8 40. Xing Y, Foy M, Cox DD, Kuerer HM, Hunt KK, Cormier JN. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg. 2006; 93:539-46. 10.1002/bjs.5209 41. Reitsamer R, Menzel C, Glueck S, Rettenbacher L, Weismann C, Hutarew G. Sentinel lymph node biopsy is precise after primary systemic therapy in stage IIIII breast cancer patients. Ann Surg Oncol. 2010

initial diagnosis and after systemic therapy N. of patients (%) N. of patients (%) N. of patients (%) Tumour stage pT1 pT2 pT3/4  Total 18 patients  7 (38.9)  7 (38.9)  4 (22.2) Post-PST ypT1 ypT2 ypT3/4  Total of 15 patients  2 (13.3)  8 (53.3)  5 (33.3) Nodal stage pNo pN1 pN2/3  Total of 22 patients  8 (36.3)  6 (27.2)  8 (36.3) Post-PST Nodal stage not determined ypN2/3  Total of 11 patients  4 (36.3)  7 (63.6) PST = primary systemic therapy Discussion Despite operative intervention and radiotherapy, loco-regional relapses can occur repeatedly, persist, or exhibit

91 [43] Seo AN, Lee HJ, Kim EJ, Jang MH, Lee HE, Kim YJ, et al. Tumor-infiltrating CD8+ lymphocytes as an independent predictive factor for pathological complete response to primary systemic therapy in breast cancer. Br J Cancer. 2013;109:2705–13. 24129232 10.1038/bjc.2013.634 Seo AN Lee HJ Kim EJ Jang MH Lee HE Kim YJ Tumor-infiltrating CD8+ lymphocytes as an independent predictive factor for pathological complete response to primary systemic therapy in breast cancer Br J Cancer 2013 109 2705 13 [44] Mahmuod SM, Paish EC, Powe DG, Macmillan RD, Grainge MJ, Lee AH

treatment as well as hormonal therapy in case of hormone receptor positive breast cancer. Echocardiography and radionuclide ventriculography At the beginning of the primary systemic therapy baseline echocardiography was performed at different clinical institutions according to the shortest waiting time for the examination. Contrary to this, all control echocardiographies were performed in one institution (Department of Cardiology, University Medical Centre Ljubljana) by three cardiologists, and they were carried out on the same device (Aloka SSD- α 10, Tokyo, Japan

- ment of choice in locally advanced breast carcinoma, and this approach is being increasingly used also in patients with operable tumors (3, 4). Although both hormonal and cytotoxic drugs may be used in primary systemic therapy, chemotherapy with cytotoxic agents is the preferred modality in most cases as the activity of hormonal therapy is restricted to patients with tumors expressing hormone receptors, and response onset is more rapid and response more pronounced with administration of cytotoxic agents. Currently, most regimens of primary systemic chemotherapy

disease accessible for R0 resection (Fig. 4.1.6 (A)–(E)). In this case, mTOR overexpression had been verified prior to the onset of CHT (cf. recurrences and metastases). These results allow the conclusion to be drawn that neoadjuvant or even primary systemic therapy with an mTOR inhibitor could bepossible in cases of PEComas that are extensive or inoperable at primary diag- nosis. In another case, dramatic tumor shrinkage was achieved under temsirolimus, 4.1 PEComa of the uterus | 131 though the PFI was only 5mo. One study recounts a case in which a patient with pelvic

LG-ESS are generally associated (107). However, the current GCIG Consensus states that the high levels of morbidity that these interventions entail need to be taken into consideration. R0 resection can have a curative effect in LG-ESS. According to recent data, subjecting local recurrences to resection leaving no gross residual disease achieves a 5-year OS of 100%. Five-year OS is still at 65% when there is gross residual disease (18, 237). Resection should also be prioritized over primary systemic therapy when treating pulmonary and liver metastases (110, 184