CLINICOPATHOLOGICAL RESPONSE AND BREAST CONSERVATION IN LOCALLY ADVANCED BREAST CANCER CASES TREATED WITH NEOADJUVANT CHEMOTHERAPY
DOI:
https://doi.org/10.61751/ijmmr/2.2024.16Keywords:
advanced cancer, invasive breast carcinoma, oncological outcomes, breast-conserving surgeryAbstract
Neoadjuvant chemotherapy is crucial for enhancing surgical outcomes and enabling breast conservation in locally advanced breast adenocarcinoma, which is often inoperable. This prospective cohort study aimed to evaluate the clinic-pathological response and breast conservation rates in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy. The patients were administered chemotherapy according to a standard protocol and were followed until their surgical outcome. Out of a total of 90 patients with locally advanced breast cancer, 78 were eligible for neoadjuvant therapy. These patients, with a mean (SD) age of 47.5 (9.4) years, were included in the study. Nearly half (52.6%) were post-menopausal; 55% (n = 43) had right breast involvement, and 57.7% (n = 45) had invasive lobular carcinoma. Approximately 47.43% of patients demonstrated a complete clinical response. In comparison, only 37% achieved a pathological complete response, which was not associated with the oestrogen receptor, progesterone receptor, or human epidermal growth factor receptor-2 status (p > 0.05). Patients who achieved a complete clinical response had a higher likelihood of undergoing breast conserving surgery (p < 0.05). The study observed that breast conservation rates were improved with neoadjuvant chemotherapy. These findings may assist clinicians in improving treatment outcomes for patients with locally advanced breast cancer
Received: 30.06.2024 | Revised: 17.09.2024 | Accepted: 26.11.2024
References
Cuniolo L, Gipponi M, Murelli F, Depaoli F, Cornacchia C, Franchelli S, et al. Multidisciplinary and tailored treatment of locally advanced breast cancer in progression during neoadjuvant chemotherapy: Case report. Curr Oncol. 2024;31(5):2856–66. DOI: 10.3390/curroncol31050217
Aebi S, Karlsson P, Wapnir IL. Locally advanced breast cancer. The Breast. 2022;62(Suppl 1). DOI: 10.1016/j.breast.2021.12.011
Dhanushkodi M, Sridevi V, Shanta V, Rama R, Swaminathan R, Selvaluxmy G, et al. Locally advanced breast cancer (LABC): Real-world outcome of patients from Cancer Institute, Chennai. JCO Glob Oncol. 2021;7:767–81. DOI: 10.1200/GO.21.00001
Marian D, Fulop ZZ, Fulop RL, Molnar AH, Scurtu A, Andercou O. Locally advanced breast cancer in Eastern European developing countries. Ann Ital Chir. 2023;94:346–50.
Gamal I. Management of a rare case of locally advanced mucinous carcinoma of the breast: A case report. Egypt J Hosp Med. 2023;91(1):5246–50.
Akbari ME, Ghelichi-Ghojogh M, Nikeghbalian Z, Karami M, Akbari A, Hashemi M, et al. Neoadjuvant vs adjuvant chemotherapy in patients with locally advanced breast cancer: A retrospective cohort study. Ann Med Surg (Lond). 2022;84:104921. DOI: 10.1016/j.amsu.2022.104921
Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, et al. Neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer: ASCO guideline. J Clin Oncol. 2021;39(13):1485–1505. DOI: 10.1200/JCO.20.03399
Pandurangappa V, Paruthy SB, Jamwal R, Singh A, Tanwar S, Kumar D, et al. Assessment of response to neoadjuvant chemotherapy in locally advanced breast carcinoma using image-guided clip placement. Cureus. 2023;15(10):e47763. DOI: 10.7759/cureus.47763
Schott K, Majer C, Bulashevska A, Childs L, Schmidt MHH, Rajalingam K, et al. AMHD1 in cancer: Curse or cure? J Mol Med. 2022;100:351–72. DOI: 10.1007/s00109-021-02131-w
Kuhl CK. The changing world of breast cancer: A radiologist's perspective. Invest Radiol. 2015;50(9):615–28. DOI: 10.1097/RLI.0000000000000166
Kuhl CK, Schild HH, Morakkabati N. Dynamic bilateral contrast-enhanced MR imaging of the breast: Trade-off between spatial and temporal resolution. Radiology. 2005;236(3):789–800. DOI: 10.1148/radiol.2363040811
Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24(13):2019–27. DOI: 10.1200/JCO.2005.04.1665
Lorentzen T, Heidemann LN, Möller S, Bille C. Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2022;48(1):44–52. DOI: 10.1016/j.ejso.2021.09.007
Piñero-Madrona A, Ruiz-Merino G, Bernet L, Miguel-Martínez B, Vicente-García F, Viguri-Díaz MA, et al. Tumoral load quantification of positive sentinel lymph nodes in breast cancer to predict more than two involved nodes. Breast. 2014;23(6):859–64. DOI: 10.1016/j.breast.2014.09.005
Hennigs A, Köpke M, Feißt M, Riedel F, Rezai M, Nitz U, et al. Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice? Breast Cancer Res Treat. 2019;173:429–38. DOI: 10.1007/s10549-018-5009-2
Morgan RL, Camidge DR. Reviewing RECIST in the era of prolonged and targeted therapy. J Thorac Oncol. 2018;13(2):154–64. DOI: 10.1016/j.jtho.2017.10.015
Ahmed KA, Correa CR, Dilling TJ, Rao NG, Shridhar R, Trotti AM, et al. Altered fractionation schedules in radiation treatment: A review. Semin Oncol. 2014;41(6):730–50. DOI: 10.1053/J.SEMINONCOL.2014.09.012
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47. DOI: 10.1016/j.ejca.2008.10.026
Dawson LA, Ménard C. Imaging in radiation oncology: A perspective. Oncologist. 2010;15(4):338–49. DOI: 10.1634/theoncologist.2009-S106
Watanabe H, Okada M, Kaji Y, Satouchi M, Sato Y, Yamabe Y, et al. New response evaluation criteria in solid tumours-revised RECIST guideline (version 1.1). Cancer Chemother. 2009;36(13):2495–501.
Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS, et al. Human epidermal growth factor receptor 2 testing in breast cancer: American society of clinical oncology/college of American pathologists clinical practice guideline focused update. J Clin Oncol. 2018;36(20):2105–22. DOI: 10.1200/JCO.2018.77.8738
Bhargavan RV, Prasannan N, Krishna KM, Augustine P, Cherian K. The role of level III dissection in locally advanced breast cancer following neoadjuvant chemotherapy – a prospective study. South Asian J Cancer. 2024;13(3):170–6. DOI: 10.1055/s-0043-1777727
Chabner BA, Longo DL. Cancer chemotherapy, immunotherapy, and biotherapy. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2024. 720 p.
The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2024 Apr 30]. Available from: https://www.wma.net/what-we-do/medical-ethics/ declaration-of-helsinki/
Chidley P, Foroudi F, Tacey M, Khor R, Yeh J, Bevington E, et al. Neoadjuvant radiotherapy for locally advanced and high-risk breast cancer. J Med Imaging Radiat Oncol. 2021;65(3):345–53. DOI: 10.1111/1754-9485.13180
Bhattacharyya T, Sharma SC, Yadav BS, Singh R, Singh G. Outcome of neoadjuvant chemotherapy in locally advanced breast cancer: A tertiary care centre experience. Indian J Med Paediatr Oncol. 2014;35(3):215–20. DOI: 10.4103/0971-5851.142038
DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69(6):438–51. DOI: 10.3322/caac.21583
van der Voort A, van Ramshorst MS, van Werkhoven ED, Mandjes IA, Kemper I, Vulink AJ, et al. Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual ERBB2 blockade in patients with ERBB2-positive breast cancer: A secondary analysis of the TRAIN-2 randomized, phase 3 trial. JAMA Oncol. 2021;7(7):978–84. DOI: 10.1001/jamaoncol.2021.1371
Kunnuru SKR, Thiyagarajan M, Martin Daniel J, Singh KB. A study on clinical and pathological responses to neoadjuvant chemotherapy in breast carcinoma. Breast Cancer (Dove Med Press). 2020;12:259–66. DOI: 10.2147/BCTT.S277588
Choudhary P, Gogia A, Deo SVS, Mathur S, Sharma D. Neoadjuvant chemotherapy in locally advanced breast cancer: Clinicopathological characteristics and correlation with pathological complete response. JCO. 2020;38:e12658. DOI: 10.1200/JCO.2020.38.15_suppl.e12658
Alawad AA. Evaluation of clinical and pathological response after two cycles of neoadjuvant chemotherapy on Sudanese patients with locally advanced breast cancer. Ethiop J Health Sci. 2014;24(1):15–20. DOI: 10.4314/ejhs.v24i1.2
Curigliano G, Ciruelos E, Kalinsky K, Proudman D, Nellesen D, Lopez P, et al. Short-term risk of recurrence in patients with HR+/HER2− early breast cancer treated with endocrine therapy in randomized clinical trials: A meta-analysis. J Clin Oncol. 2024;42:541. DOI: 10.1200/JCO.2024.42.16_suppl.541
Loibl S, Jackisch C, Lederer B, Untch M, Paepke S, Kümmel S, et al. Outcome after neoadjuvant chemotherapy in young breast cancer patients: A pooled analysis of individual patient data from eight prospectively randomized controlled trials. Breast Cancer Res Treat. 2015;152:377–87. DOI: 10.1007/s10549-015-3479-z
Mermut O, Inanc B, Gursu RU, Arslan E, Trabulus DC, Havare SB, et al. Factors affecting pathological complete response after neoadjuvant chemotherapy in breast cancer: A single-center experience. Rev Assoc Med Bras (1992). 2021;67(6):845–50. DOI: 10.1590/1806-9282.20210114
Agrawal SK, Patel D, Shenoy P, Ahmed R, Arun I, Chatterjee S. Oncologic safety of breast conservation following NACT in women with locally advanced breast cancer. Ecancermedicalscience. 2023;17:1554. DOI: 10.3332/ecancer.2023.1554
Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, et al. Primary surgery with systemic therapy in patients with de novo stage IV breast cancer: 10-year follow-up; protocol MF07-01 randomized clinical trial. J Am Coll Surg. 2021;233(6):742–51.e5. DOI: 10.1016/j.jamcollsurg.2021.08.686
Kwon MR, Choi JS, Won H, Ko EY, Ko ES, Park KW, et al. Breast cancer screening with abbreviated breast MRI: 3-year outcome analysis. Radiology. 2021;299(1):73–83. DOI: 10.1148/radiol.2021202927
Sun Y, Liao M, He L, Zhu C. Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2017;96(43):e8367. DOI: 10.1097/MD.0000000000008367
Spring LM, Fell G, Arfe A, Sharma C, Greenup R, Reynolds KL, et al. Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: A comprehensive meta-analysis. Clin Cancer Res. 2020;26(12):2838–48. DOI: 10.1158/1078-0432.CCR-19-3492
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