Abstract
Objective: To evaluate all the known factors that may play a role in predicting response to Neoadjuvant chemotherapy in breast cancer and to see impact of response on five years’ disease free survival (DFS) and Overallsurvival (OS). Material and Method: Data of 156 patients was reviewed retrospectively from January 2012 to December 2012 at Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore, Pakistan. All received neoadjuvant chemotherapy (NAC) and had no distant metastasis. The response was measured in term of percentage reduction from 1st radiological size on presentation to final size on histopathology (of resected specimen). Four groups were identified, complete responder (CR) (100% reduction), Responders (R) (>50% reduction), Partial responder (PR) (<50% reduction) and Non-responder (NR). Relationship of predictive factors with each response group was observed. Five year survival was noted for each response group. Result: Median age of patients was 45 years (25-64 years). 67% of patients underwent breast conservation surgery, while the rest underwent mastectomy. Mortality for whole group was 22%, and recurrence was shown in 34% (Majority i.e. 26% were distant, while contralateral were 3%). Out of 156 patients, 25% of patients were CR, 13% were NR, 23% were PR and 37% were R. Progesterone receptor negative and Grade III tumors showed more complete responses. The Rest of the receptor types, including triple negative, initial T and N stage and other clinical factors showed no impact on chemo-response. Survival was significantly poor in NR group (45% OS, 40% DFS), while rest of three groups had comparable survival outcome, with CR group having best survival outcome (86% OS, 80% DFS). Conclusion: Most of factors studied did not show impact on achieving good chemo response, however good chemo response did show better survival.
Highlights
Breast cancer accounts for 23% of total cancer cases worldwide and 14% of all cancer deaths [1]
The rationale of this study is to evaluate all the known factors that may play a role in predicting response to chemotherapy and to see impact of response on five years disease free survival (DFS) and overall survival (OS)
SLNB was performed at diagnosis before starting neoadjuvant chemotherapy (NAC) in radiologically negative axilla or in those who were negative on FNA. 87 (56%) patients underwent SLNB, 69 patients were positive on FNA (44%) at presentation lymph nodes were positive in 102 patients (66%) and all underwent axillary clearance after completion of chemotherapy
Summary
Breast cancer accounts for 23% of total cancer cases worldwide and 14% of all cancer deaths [1]. As per World Health Organization (WHO), breast cancer affects more than 1.2 million people every year [2]. According to GLOBOCAN 2018, breast cancer is the leading cause of cancer death among females [3]. In the last few decades, neoadjuvant chemotherapy (NAC) has become a standard treatment in the management of breast cancer. The United States National Cancer data database reported an increase in usage of NAC from 15.7% to 26% in 2015 [5, 6]. Potential benefits of NAC are killing systemic micrometastasis right from beginning, achieving higher rates of breast conservative surgery (BCS), allowing in vivo evaluation of chemo sensitivity and subsequently changing chemo regimen [7]
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