Effect of Neoadjuvant Concurrent Chemoradiation on Operability and Survival in Locally Advanced Inoperable Breast Cancer

Abstract

PurposeInoperable locally advanced breast cancers (LABC) are treated with neoadjuvant chemotherapy (NACT). We studied the use of neoadjuvant concurrent chemoradiation (NACCRT) in patients with inoperable LABC. Patients and MethodsFrom May 2017 to Dec 2021, the study recruited patients with Stage III inoperable LABC. The treatment included 4 cycles of Adriamycin and Cyclophosphamide and 4 cycles of Paclitaxel, along with concurrent radiotherapy to a total dose of 46 Gy. Thereafter, all patients were evaluated for surgery, and additional treatments were given based on receptor status. The effects of NACCRT on the pathological complete response (pCR), operability, and survival were analyzed. ResultsThe study involved 202 female patients with a median age of 52 years. Of these, 23.7% had IIIA, 65.3% had IIIB, and 10.8% had IIIC disease. Hormone-receptor (HR) positive disease was observed in 44.6% of patients, triple-negative breast cancer (TNBC) in 24.8%, and HER2-positive disease in 30.7%. Modified radical mastectomy (MRM) was performed in 88.1% of patients, 8.5% remained inoperable, and 3.4% declined surgery. Among the patients who underwent MRM, 36.5% of patients had a pCR. Patients who were operable and underwent MRM had complete resections and had negative margins. pCR was observed in 16% with HR-positive disease, 45.6% with TNBC, and 60.7% with HER2-positive disease. Grade 3 skin reactions were observed in 19.3%. Postoperative wound morbidity requiring hospitalization was observed in 10.6% of patients.After a median follow-up of 42 months, the 4-year EFS and OS were 63.4% and 71.5%, respectively. HER2-positive patients who achieved pCR had significantly improved EFS and OS. ConclusionsOur study shows that using NACCRT can improve operability and survival outcomes in patients with inoperable LABC.