Neoadjuvant Chemotherapy and Surgical Options for Locally-advanced Breast Cancer: A Single Institution Experience
Background: Neoadjuvant chemotherapy can downstage the size of the tumor, thus allowing some patients with advanced disease with the option of conservative breast surgery. Our study aims to investigate the effectiveness of neoadjuvant chemotherapy in patients with locally advanced breast cancer.
Methods: Fifty-six patients had locally advanced breast cancer. Ten patients (18%) were stage IIB, 32 (57%) were stage IIIA, 9 (16%) were stage IIIB, and 5 (9%) were stage IIIC. Patients received neoadjuvant chemotherapy comprised of cyclophosphamide, doxorubicin, and fluorouracil followed by surgery (15 patients with breast conservative surgery,11 with skin sparing mastectomy and latesmus dorsi reconstruction, and 30 patients who underwent modified radical mastectomy) and then followed by radiotherapy, 50 Gy with conventional fractionation.
Results: Clinical down staging was obtained in 49 (87.5%) patients: 5 (9%) had complete clinical response, 44 (78.5%) had partial response, 6 (10.7%) had stable disease, and 1 (1.8%) had progressive disease. The primary tumor could not be palpated after chemotherapy in 7 (12.5%) of 56 patients who presented with a palpable mass. Median follow-up was 47.5 months. The factors that correlated positively with locoregional recurrence on univariate analysis included hormonal receptor status and surgical margin status. On multivariate analysis, surgical margin status was the only independent significant factor for locoregional recurrence-free survival. In univariate analysis for distant relapse free survival, factors that correlated positively included disease stage and hormonal receptor status. Multivariate analysis showed that tumor stage and hormonal receptor status were independent significant factors that correlated with distant relapse-free survival.
Conclusion: Neoadjuvant chemotherapy was effective in clinical down staging and should be considered for patients with advanced breast cancer. It improved operability and enhanced local control and increased the possibility of breast-conserving surgery without affecting overall survival. Negative surgical margin was the independent significant factor in terms of locoregional recurrence while tumor stage and hormonal receptor status were the independent significant factors in term of distant relapse free survival.
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