A study on role of neo adjuvant chemotherapy in locally advanced non-metastatic breast cancer
DOI:
https://doi.org/10.18203/2349-2902.isj20181999Keywords:
FAC regime, Locally advanced non-metastatic breast cancer, Neo adjuvant chemotherapyAbstract
Background: Nearly 1.7 million new breast cancer cases were diagnosed worldwide in 2012.Breast cancer is the second most common cancer in women worldwide. Globally, breast cancer now represents one in four of all cancers in women. breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,00 women and mortality 12.7 per 100,000 women. Around 90,000 new cases of breast cancer are diagnosed every year in India and majority present as Locally Advanced Breast Cancer (LABC). Neo adjuvant chemotherapy is a commonly used modality for LABC, that gives an upfront systemic therapy in high risk patients with expected micro metastatic burden and also helps in down staging the disease and offering radical cure.
Methods: All Locally Advanced Non-Metastatic Breast Carcinoma (T3 N0, T3 N1, T4a, T4b, T4c, Any N2/N3, MO patients who received Neo Adjuvant Chemotherapy and underwent surgery were included. All these patients received 5-Fluorouracil, Adriamycin and Cyclophosphamide (FAC) regime, following therapy patients were offered either Modified Radical Mastectomy or Breast Conservative Surgery with axillary node dissection and Radiotherapy.
Results: Complete response was achieved in 20 (66.6%) patients,3 (10%) of the patients had partial response and 7 (23.3%) progressed clinically.
Conclusions: Neo adjuvant chemotherapy helped to study response of tumour size to NAC, down stage disease and to convert inoperable cases to resectability.
Metrics
References
Naji S,Alexander E , Robert W. Locally advanced breast cancer.Treatment guideline implementation with particular attention to low and middle income countries.Cancer 2008;113:2315-24.
Kuerer HM, Singletary SE, Buzdar AU, Ames FC, Valero V, Buchholz TA et al. “Surgical conservation planning after neoadjuvant chemotherapy for stage II and operable stage III breast carcinoma” Am J Surg. 2003;182:601-8
Iqbal J, Kausar B, Saeed A, Akram M, Zeba A. Survival of women with locally advanced breast cancer at a teaching hospital in Lahore.J Pak Med Assoc. 2010;60:721-5.
Buzdar AU. Pre-operative chemotherapy treatment of breast cancer; a areview. Cancer. 2007;110:2394-407.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R et al. New response evaluation criteria in solid tumours:Revised RECIST guideline. Eur J Cancer 2009;45:228-47.
Vicente V, Aman UB, Gabriel NH. Locally advanced breast cancer. Oncologist. 1996;1:8-17.
El-Sayed MI, Maximous DW, Aboziada MA, Abdel-Wanis ME, Mikhail NN. Feasibility of breast conservation after neoadjuvant taxene based chemotherapy in locally advanced breast cancer: a prospective phase-I trial. ANN Surg Innov Res. 2010;4:5.
Machiavelli MR, Romero AO, Perez JE, Lacava JA, Dominguez ME, Rodriguez R, et al. Prognostic significance of pathological response of primary tumor and metastatic axillary lymphnodes after neoadjuvant chemotherapy for locally advanced breast carcinoma. Cancer J Sci Am. 1998;4:125-31.
Viswambharam JK, Kadambari D, Iyengar KR, Srinivasan K. Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: a study in mastectomy specimens using simulation lumpectomy. Indian J Cancer. 2005;42:30-4
Yadav BS, Sharma SC, Singh R, Singh G. Pateerns of relapse in locally advanced breast cancer treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. J Cancer Res Ther 2007;3:75-80.
ElBakary TA, ElGohary SE, Elgendy MM, Barakat AF, Younes SG. Conservative breast surgery in early and locally advanced breast cancer. J Am Sci 2010;6:713-20.
Kim R, Osaki A, Tanabe K, Toge T. Neo adjuvant chemotherapy for locally advanced breast cancer with stage III-B. Oncol Rep. 2004;11:1265-72.
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;82:1539-45.
Fisher B, Bryant J, Wolmark N. Effect of pre-operative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 1998;16:2672-85.
Danforth DN Jr, Zujewski J, O’Shaughnessy J, Riseberg D, Steinberg SM, McAtee N, et al. Selection Of local therapy after neoadjuvant chemotherapy in patients with stage III-A, B breast cancer. Ann Surg Oncol.1998;5,2:150-8.