DOI: http://dx.doi.org/10.18203/2349-2902.isj20200309

Role of neoadjuvant chemotherapy in downstaging locally advanced breast carcinoma, selection of surgical procedure and its outcome

Dakshayani S. Nirhale, Rizhin Sooraj, Anshu Rawat

Abstract


Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.

Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.

Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy which was statistically significant. Only 4 out of the total 12 complete clinical responders went for Breast conservative surgery. Seroma formation was found to be the most common post-operative complication.

Conclusions: LABC subjected to neoadjuvant chemotherapy based on taxanes/Anthracyclines show good clinical and radiological response. Patients preferred modified radical mastectomy due to the lack of awareness and low socioeconomic strata.The type of surgery did not increase  the chance of recurrence in the follow up period.

 


Keywords


Breast conservation surgery, Locally advanced breast cancer, Neoadjuvant chemotherapy

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References


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2018;68(6):394-424.

DeVita VT, Lawrence TS, Rosenberg SA, editors. DeVita, Hellman, and Rosenberg's cancer: principles & practice of oncology.11th edition. Lippincott Williams & Wilkins; 2008;2(79):252-67.

Tewari M, Krishnamurthy A, Shukla HS. Predictive markers of response to neoadjuvant chemotherapy in breast cancer. Surg Oncol. 2008;17(4):301-11.

Mathew J, Asgeirsson KS, Agrawal A, Mukherjee A, Ellis IO, Cheung KL. Neoadjuvant chemotherapy in locally advanced primary breast cancers: The Nottingham experience. Euro J Surg Oncol. 2007;33:972-6.

Yao X, Hosenpud J, Chitambar CR, Charlson J, Cheng YC. A Phase II study of concurrent docetaxel, epirubicin and cyclophosphamide as a neoadjuvant chemotherapy regimen in patients with locally advanced breast cancer. J Cancer 2012;3:145-51.

Parmar V, Nair NS, Badwe RA, Hawaldar R, Shet T, Desai S. Pathological complete response in locally advanced breast cancer: Determinants and predictive significance. Natl Med J India. 2012;25:132-6.

Polychemotherapy for early breast cancer: An overview of randomised trials. Early Breast Cancer Trialists′ Collaborative Group. Lancet. 1998;352:930-42.

Bull JM, Tormey DC, Li SH, Carbone PP, Falkson G, Blom J, et al. A randomised comparative trial of adriamycin versus methotrexate in combination drug therapy. Cancer. 1978;41:1649-57.

Falkson G, Tormey DC, Carey P, Witte R, Falkson HC. Long-term survival of patients treated with combination chemotherapy for metastatic breast cancer. Eur J Cancer. 1991;27:973-7.

Gupta D, Raina V, Rath GK, Shukla NK, Mohanti BK, Sharma DN. Clinical and pathological response rates of docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer and comparison with anthracycline-based chemotherapies: Eight-year experience from single centre. Indian J Cancer. 2011;48:410-4.

Parmar V, Krishnamurthy A, Hawaldar R, Nadkarni MS, Sarin R, Chinoy R, et al. Breast conservation treatment in women with locally advanced breast cancer–experience from a single centre. Inter J Surg. 2006;4(2):106-14.

Gedam MC, Shukla K, Ingale LY. Clinical presentation and management of locally advanced breast carcinoma. Int Surg J. 2018;5(11):3690-2.

Cance WG, Carey LA, Calvo BF, Sartor C, Sawyer L, Moore DT, et al. Long-term outcome of neoadjuvant therapy for locally advanced breast carcinoma: effective clinical downstaging allows breast preservation and predicts outstanding local control and survival. Ann Surg. 2002;236(3):295-303.

Mukherjee P, Sharma S, Sheikh ZA, Vijaykumar DK. Correlation of clinico-pathologic and radiologic parameters of response to neoadjuvant chemotherapy in breast cancer. Ind J Cancer. 2014;51(1):25-9.

Chen Z, Yang J, Li S, Lv M, Shen Y, Wang B, et al. Invasive lobular carcinoma of the breast: A special histological type compared with invasive ductal carcinoma. PLoS ONE 2017;12(9).

Chand P, Garg A, Singla V, Rani N. Evaluation of immunohistochemical profile of breast cancer for prognostics and therapeutic use. Nig J Surg. 2018;24(2):100-6.

Bhattacharyya T, Sharma SC, Yadav BS, Singh R, Singh G. Outcome of neoadjuvant chemotherapy in locally advanced breast cancer: A tertiary care centre experience. Indian J Med Paediatr Oncol. 2014;35(3):215-20.

Mustacchi G, De Laurentiis M. The role of taxanes in triple-negative breast cancer: literature review. Drug Design, Develop Therapy. 2015;9:4303-18.

Chatterjee S, Mukherjee MM, Nath NC, Samanta S, Saha AK. An observational study on the incidence of HER-2/neu receptor over-expression and comparison of clinical presentation between HER-2/neu positive and HER-2/neu negative breast cancer. Inter Surg J. 2017;4(2):506-13.

Narendra H, Thomas J, Ray S, Fernandes DJ. An analysis of response to neo-adjuvant chemotherapy in patients with locally advanced breast cancer with emphasis on pathological complete response. Ind J Cancer. 2014;51(4):587-92.

Schwartz GF, Birchansky CA, Komarnicky LT, Mansfield CM, Cantor RI, Biermann WA, et al. Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breast. Cancer. 1994 Jan 15;73(2):362-9.

Chandrakar N, Shinde RK. Study the early complications of modified radical mastectomy performed. Int Surg J. 2019;6(1):239-43.

Kumar A, Nathani N, Kumar S. A prospective study of wound complications in cancer breast surgery following neoadjuvant chemotherapy. Inter Surg J. 2018;6(1):22-7.

Bria E, Nistico C, Cuppone F, Carlini P, Ciccarese M, Milella M, et al. ‘Benefit of taxanes as adjuvant chemotherapy for early breast cancer.’ Interdiscipl j Am cancer soc. 2006;106(11):2337-44.

Azizun-Nisa BY, Raza F, Kayani N. Comparison of ER, PR and HER-2/neu (C-erb B 2) reactivity pattern with histologic grade, tumor size and lymph node status in breast cancer. Asian Pac J Cancer Prev. 2008;9(4):553-6.

Haque R, Ahmed SA, Fisher A, Avila CC, Shi J, Guo A, et al. Effectiveness of aromatase inhibitors and tamoxifen in reducing subsequent breast cancer. Cancer Med. 2012;1(3):318-27.

Carrara GF, Scapulatempo-Neto C, Abrahão-Machado LF, Brentani MM, Nunes JS, Folgueira MA, et al. Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up. Clinics. 2017;72(3):134-42.