Does neoadjuvant chemotherapy in operable breast cancer increase breast conservation?

Abstract

11572 Background: The role of adjuvant chemotherapy in breast cancer is well established. Likewise the role of neoadjuvant chemotherapy in locally advanced breast cancer is well established. The use of neoadjuvant chemotherapy in operable breast cancer has only recently become of interest to researchers. Methods: This study included 34 patients of operable breast cancer who were given 4 cycles of neoadjuvant chemotherapy in the form of FEC-100 then subjected to surgery. Surgery done was either breast-conserving surgery (BCS) or modified radical mastectomy. All surgical specimens were studied pathologically for chemotherapy effect. Results: An overall objective response was observed in 70.6% of the patients. Seven patients (20.6%) experienced a clinical complete response (cCR), seventeen patients (50.0%) had partial response, nine patients (26.5%) had no change of their disease, and only one patient had disease progression. Of the seven patients who had a cCR, only four patients (11.8%) had pathologic complete response (pCR), while pCR for the whole group was14.7 %( 5/34). Tumour size of more than 2 cm was observed in 28 patients (82.4%) at time of presentation, while tumor size of 2 cm or less was seen in 6 patients (17.6%) only. After completion of the course of chemotherapy, twenty-three patients (67.6%) were observed to have tumors of 2 cm or less that allowed for less extensive resections. Twenty-three patients underwent breast-conserving surgery (67.6%) while modified radical mastectomy was performed in 11 patients (32.4%). Conclusions: The use of neoadjuvant chemotherapy in operable breast cancer in this study was associated with tumour and axillary downstaging which increased the proportion of cases undergoing breast conservation, with acceptable side effects and reasonable cost. During the limited follow-up period of this study, no locoregional recurrences were recorded and one distant treatment failure was recorded. Its impact -if any- on overall or disease-free survival was not addressed in this study. Larger multicenter randomized studies with long follow-up periods are needed to compare the overall and disease-free survival benefit of this treatment modality, especially in different subtype stratified by pathologic response. No significant financial relationships to disclose.