Abstract
BackgroundNeoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC). Improved response to NAC correlates with better survival outcomes. The dual purpose of this study is to report recurrence and survival outcomes for LABC patients treated with NAC, surgery and adjuvant radiotherapy and to correlate these outcomes with tumour response after NAC using multiple response assessment methods.MethodsAll LABC patients treated for curative intent with NAC, surgery, and adjuvant radiotherapy at our institute between January 2009 and December 2014 were included for analysis. NAC was mostly anthracycline and taxane-based; radiotherapy consisted of 50 Gy to the breast/chest wall and regional lymph nodes. Response to NAC was categorized using synoptic pathology reports, modified-RECIST and Chevallier scores. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test.ResultsThe cohort included 103 patients nearly equally divided between Stage II (n = 53) and Stage III (n = 50). Rates of locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were 99, 98, and 100% at 1 year and 89, 69 and 77% at 5 years, respectively. Responses to NAC did not correlate with LRC (p > 0.05) but did correlate with RFS and OS (p < 0.05), except that the Chevallier score did not predict RFS (p = 0.06). Using bivariate Cox modeling tumour size before (p = 0.003) and after (p < 0.001) NAC, stage group (p = 0.05), and response assessed by synoptic pathology (p = 0.05), modified-RECIST (p = 0.001), and Chevallier score (p = 0.015) all predicted for RFS. No factors predicted for LRC.ConclusionPathologic response by all tested methods correlated with improved survival but were not associated with decreased LRC.
Highlights
Neoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC)
Subsequent retrospective studies [13, 14] have suggested that adjuvant radiation therapy (RT) decreases the rate of locoregional recurrence (LRR) and improves survival after NAC and surgery, but this has not been evaluated with randomized trials
All 103 patients in our cohort were evaluated for primary tumour response to NAC using three methods: standard pathology, modified RECIST criteria-based (MR) score, and Chevallier score
Summary
Neoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC). Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with locally advanced breast cancer (LABC) [1,2,3]. Such regimens can increase rates of breast-conserving therapy (BCT) compared with post-operative chemotherapy [2] and may minimize the. Patients who underwent breast conserving surgery (BCS) after NAC received whole breast radiation therapy (RT) alone, while mastectomy patients did not receive RT These trials demonstrated locoregional recurrence rates of 12.3% for mastectomy patients and 10.3% for BCS patients [12]; overall survival (OS) rates were 75% at 8 years [6]. Given the absence of level I evidence, routine practice at our centre is to offer radiation therapy after NAC and surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
