Affect of Neo-Adjuvant Chemotherapy in Management of Locally Advanced Breast Carcinoma

Abstract

Background: Introduction of neoadjuvent chemotherapy (NACT) has dramatically changed the management of locally advanced breast cancer (LABC).The neo-adjuvant chemotherapy (NACT) has become the initial standard treatment of locally advanced breast carcinoma cases followed by surgery, adjuvant chemotherapy, radiotherapy with or without hormonal therapy.Historically these cases with clinically locally advanced breast carcinoma were treated with radical surgery and/or radiation therapy (RT).However the management of LABC has dramatically transformed over past two decades {Bangladesh journal references 1-4}.Primary chemotherapy (CT) became an integral part of the multidisciplinary management of LABC, probably prolonging the disease free survival and overall survival and making breast conserving, less radical surgeries a possibility for these patients.{bangladeshjournal} Materials and Methods: All female patients with FNAC or core needle biopsy proven breast carcinoma attending general surgery department and specialty breast clinic at NRI general hospital, chinakakani, Guntur during two years of study.Sample size of 30 / study period two years.Results: Assessment of the clinical response was based on RECIST criteria with complete response in (CR) 4 cases (13.33%) partial response in (PR) 25 no (83.32%);minimal response or stable disease in (MR) 1 (3.33%); progressive disease in (PD) zero cases.Complete clinical response by clearance of axillary nodes is seen in 11(64.70%) of cases.No or partial response was seen in 6(35.29%).Assessment of the pathological response from the final surgical specimen showed Complete response pCR 3 (9.99%)Partial Response pPR 25(83.32%)Stable diseases SD 2(6.66%)Progressive diseases pPd 0 (0%) Conclusion: Neoadjuvent chemotherapy is a reasonable alternative to upfront surgery in the management of LABC.Clinicopathological variables such as nodal status, response to chemotherapy, pathological tumor size and presence of ECE had significant impact on disease free survival.