Aerosolization of Thermosensitive Hydrogels using Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

Introduction Surgical oncologists must often weigh the risks and benefits of breast surgery in elderly or comorbid patients. An emerging non-surgical option is to initiate primary endocrine therapy without a plan for surgery unless necessary. However, median time to progression in newly-diagnosed patients who opt for primary endocrine therapy has not been described, and the proportion of patients who will eventually need salvage surgery is unknown. Methods A retrospective review of newly-diagnosed patients receiving primary endocrine ablative therapy at a single institution in Brooklyn, New York was performed. Time to progression and the rate of salvage surgery was determined. Progression was defined as a change in imaging or physical exam that led to a change in therapy. Tumor size was measured over time with mammogram, sonogram, MRI or physical exam. Reasons for a change in therapy were documented as progression of disease or intolerable side effects. Results Between January 2006 and October 2020, 95 women with estrogen receptor (ER) positive breast cancer received primary endocrine therapy due to comorbidities, advanced age, preference and/or tumor size (Table 1). The median Charlson Comorbidity Index was 5, translating to an estimated 10-year survival of 21%. Most of the patients had early stage node-negative disease and almost all received an aromatase inhibitor. The median time to progression was 20.4 months (13.5–28.5) with a median follow-up of 30.5 months (longest 177.2 months). Of the 24 patients (25.3%) who had a progression while on therapy, 14 patients (14.7%) underwent salvage surgery …