Surgical Oncology

Tumor bed biopsy after neoadjuvant chemotherapy is unreliable to confirm pCR in breast cancer

In this meta-analysis of cCR breast cancer after neoadjuvant chemotherapy, tumor bed biopsy had pooled sensitivity 58% and specificity 100%. The false-negative rate was 42%, meaning almost half of residual tumors would be incorrectly labeled as pathologic complete responses. While positive biopsies reliably identify residual disease, negative biopsies cannot safely replace standard surgical excision. Current performance does not support tumor bed biopsy alone for surgical de-escalation or omission of breast surgery outside trials. 1

Prophylactic nipple-sparing mastectomy shows excellent long-term oncologic safety

This single-institution series reported 1,255 prophylactic nipple-sparing mastectomies in 972 patients, with median follow-up of about 81 months. Incidental breast cancer was detected in 3.0% of breasts on final pathology. Only 3 new primary breast cancers (0.3%) occurred after prophylactic nipple-sparing mastectomy. Five-year risks of new breast cancer, breast cancer mortality, and overall mortality were low in the overall and BRCA-only cohorts. These data support prophylactic nipple-sparing mastectomy as an oncologically safe risk-reduction option with appropriate selection and counseling. 2

HAIP chemotherapy yields transplant-comparable survival in a small subset of unresectable CRLM

Among 483 unresectable colorectal liver metastasis patients treated with HAIP, only 23 (4.8%) met strict liver transplant eligibility criteria. Despite extensive disease, 78% of these patients converted to resection after a median of 5 HAIP cycles. Median overall survival was 61 months, with 5-year overall survival of 53%, comparable to recent liver transplant trials. Median progression-free survival from HAIP placement was 13 months. For carefully selected transplant-eligible patients, HAIP plus conversion surgery offers a non-transplant strategy achieving similar long-term survival. 3

SBRT alone for oligometastatic disease allows systemic-therapy deferral with low severe toxicity

This systematic review included 29 studies and 2,074 patients receiving metastasis-directed SBRT without upfront systemic therapy for ≤5 metastases. Across 13 studies, pooled 1–2 year systemic-therapy–free survival was 69.7%, indicating many patients avoided systemic therapy for at least one year. Renal cell and prostate cancers showed the highest systemic-therapy–free survival, 87.0% and 78.1%, respectively. Grade ≥3 toxicity was absent in most series and, when present, occurred in up to 8.8% of patients. These data support SBRT alone as a low-morbidity option to defer systemic therapy in selected oligometastatic patients, especially renal and prostate. 4