Neoadjuvant chemotherapy (NACT) is being increasingly prescribed. MDT planning and surgical decisions post NACT vary around the country.
This survey aims to get an idea of surgical practice, and opinions and attitudes following NACT.

Neoadjuvant Chemotherapy: Does this affect your surgical practice?

Thank you for taking the time to read this. We have developed this quick survey from Winchester Breast Unit with the aim of finding out what different units do around the country, and why. We would be very grateful if you would help us by completing the 10 questions below. I am happy to receive any additional comments to belindapearce@doctors.org.uk.

Thank you very much in advance,

Belinda Pearce (ST7 Breast Trainee, Wessex Deanery)

Miss Siobhan Laws and Mr Dick Rainsbury (Consultant Oncoplastic Surgeons), Royal Hampshire County Hospital, Winchester.

Question Title

* 1. What are your main reasons for recommending NACT in a patient?

I don't recommend NACT

To downsize the tumour and change surgical planning

To assess tumour response to chemotherapy and prognosis

To change chemotherapy regime in non-responders

To prioritise treatment of occult metastases

Other (please specify)

Question Title

* 2. How often do you place a marker clip early on in a patient's NACT treatment?

All the time

Most of the time

Some of the time

Occasionally

Never

Question Title

* 3. If NACT has reduced the tumour size both clinically and on imaging, would you:

Resect the original tumour footprint

Resect the smaller reduced sized tumour

Not sure

Comment

Question Title

* 4. If NACT has produced a complete pathological response on imaging and clinical assessment, would you:

Resect original tumour footprint

Resect the marker clip and a rim of tissue around it

Marker clips not placed so I would resect a small volume of breast issue in the region where the original tumour was

Consider no surgery to the breast

Other (please specify)

Question Title

* 5. If you excise original footprint, which one of the following statements best describes your rationale?

Lack of evidence for safety of downsizing

Suspected increased risk of local recurrence

Suspect that most tumours shrink non-concentically

I perform oncoplastic techniques that mean I can take the footprint without having a negative impact on cosmesis

To avoid re-operation

Other (please specify)

Question Title

* 6. Which one of the following statements best describes your understanding of tumour reaction to NACT?

Most tumours reduce in size concentrically

Most tumours reduce in size in a 'swiss cheese' pattern i.e. leaving clumps of cancer cells separate to the main tumour

The response varies depending on tumour type

The effect is entirely random

I don't know

Comment

Question Title

* 7. If you perform end of NACT imaging, which of the following investigations do you perform?

Ultrasound

Mammogram

MRI

I do not perform end of NACT imaging

Question Title

* 8. To help plan subsequent surgery, after NACT do you perform:

Pre-operative margin core biopsies

Intra-operative margin analysis with imprint cytology

Intra-operative margin analysis with frozen section

Intra-operative margin analysis with iknife imprint cytology

Intra-operative specimen radiology

None of the above

Other (please specify)

Question Title

* 9. If you do not perform preoperative margin assessment after apparent tumour shrinkage from NACT, what is your reasoning?

This would not help decision making

This does not guarantee detection of cancer at the peripheries i.e. areas could be missed

Radiologist reluctance

Risks to patient of multiple biopsies

Perceived unacceptability to patients of multiple biopsies

Lack of time

Comment

Question Title

* 10. Do you think margin re-excision is more frequent in patients who have had BCS post NACT than those who have not had any NACT?

Yes

Don't know

100% of survey complete.