52 Rates of local recurrence with neoadjuvant chemoendocrine therapy for primary breast cancer

Abstract

Breast conservation surgery for early breast cancer is associated with equivalent survival, but higher rates of local relapse than mastectomy. Pathological margin status and EIC are major determinants of relapse risk. In a randomised trial of chemoendocrine therapy administered either prior to or following primary surgery and radiotherapy, we have assessed neoadjuvant and adjuvant regimens on rates of loco-regional relapse. The first 200 patients (≤age 70 years) with operable stage I and II breast cancer diagnosed on fine needle aspirate have been analysed. Those in the adjuvant group received 6 months of chemotherapy together with tamoxifen (continued for 5 years) whilst 3 months of chemoendocrine therapy before and after appropriate surgery and radiotherapy was given as a neoadjuvant schedule. Overall clinical response rates for the latter have been high (85%), and at a median follow up of 28 months, only 4 patients have relapsed locally in either the breast (2 adjuvant, 1 neoadjuvant) or axilla (1 adjuvant). Lower rates of recurrence have occurred in the neoadjuvant group despite a greater proportion of positive pathological margins (28% neoadjuvant, 24% adjuvant). Tumour grade and extent of DCIS were similar for the two groups ( P > 0.05), with significantly more rumours ≤2 cm present in the neoadjuvant group ( P