Clinicopathological response assessment to neoadjuvant chemotherapy in locally advanced breast cancer- A rural population-based case series

Abstract

Introduction:  Breast cancer is the commonest malignancy among women worldwide. Despite a multidisciplinary approach, locally advanced breast cancer remains a clinical challenge as most of the patients have a high rate of locoregional spread and develop distant metastases. Neoadjuvant chemotherapy not only paves the way for a more conservative surgical option but also decreases the incidence of positive nodes. To assess the effectiveness of neo-adjuvant chemotherapy and its impact on clinical and pathological response in locally advanced breast cancer. To compare patient characteristics, histological type, and hormonal receptor status with response to neo-adjuvant chemotherapy.

Materials and Methods: This is a prospective observational study over a one-year period on 30 locally advanced breast cancer patients from rural backgrounds who received neoadjuvant chemotherapy. All patients received a standard neoadjuvant treatment regimen and were evaluated clinically, radiologically, and pathologically pre- and post-chemotherapy. The clinical response was assessed by RECIST criteria, the pathological response was graded according to Chevalier classification, and the overall impact was assessed by AJCC response criteria.

Results: Most of the patients (46.7%) were in the age group of 35-48 years. The premenopausal and postmenopausal groups were 63% and 37%, respectively. In the present study, tumours expressing estrogen, progesterone, and HER 2 were 73%, 66%, and 27%, respectively. Patients showing clinically complete responses post-neoadjuvant chemotherapy were 4, partial responses were 21, stable disease was 3, and progressive disease was 2. A pathological partial response was achieved in 93% of patients.

Conclusion: Neoadjuvant chemotherapy in locally advanced breast cancer not only downstages the disease but increases the scope of operability and thus makes it possible to resect the disease with a tumour-free margin in most cases.