Sethi D, Sen R, Parshad S, Khetarpal S, Garg M, Sen J
Department of Pathology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, India.
Indian J Cancer. 2013 Jan-Mar;50(1):58-64. doi: 10.4103/0019-509X.112301.
To compare the clinical and pathologic assessment of response to neoadjuvant chemotherapy and describe the various histopathologic changes observed.
We studied a group of 40 patients with locally advanced breast cancer who had their initial workup in the form of clinico-imaging assessment of the size and pretreatment biopsy from the lesion. All the patients received two to six cycles of neoadjuvant chemotherapy, either cyclophosphamide 50 to 60 mg/m 2 IV, doxorubicin 40 to 50 mg/m 2 IV and 5-fluorouracil 500 to 800 mg/m 2 IV (CAF) or cyclophosphamide, epirubicin, and 5-fluorouracil (CEF). Clinical and pathologic assessment of response to chemotherapy was done based on the UICC guidelines.
Complete clinical response (cCR) was seen in 10% cases (4/40), thirty percent patients had (12/40) partial response and 60% (24/40) had stable disease after neoadjuvant chemotherapy. Pathologic complete response (pCR) with no evidence of viable tumor was observed in 20% patients (8/40). Fifteen patients (37.5%) showed partial response and 42.5% patients (17/40) had a stable disease. No patient progressed during the course of chemotherapy. Changes in the tumor type were observed following chemotherapy, most common being the mucinous change. Histologic changes like dyscohesion, shrinkage of tumor cells, elastosis, collagenization, necrosis, lymphocytic reaction, giant cell response are some of the common observations seen following treatment with neoadjuvant chemotherapy.
Pathologic assessment of response to neoadjuvant chemotherapy is a better predictor than the clinical response. The chemotherapy drugs can be modified based on the response observed after 1-2 cycles of neoadjuvant, the response being based on both tumor and patient's responsiveness.
比较新辅助化疗反应的临床和病理评估，并描述观察到的各种组织病理学变化。
我们研究了一组40例局部晚期乳腺癌患者，他们最初通过对病变大小进行临床影像学评估和预处理活检进行初步检查。所有患者接受了2至6个周期的新辅助化疗，方案为环磷酰胺50至60mg/m²静脉注射、阿霉素40至50mg/m²静脉注射和5-氟尿嘧啶500至800mg/m²静脉注射（CAF）或环磷酰胺、表柔比星和5-氟尿嘧啶（CEF）。根据国际抗癌联盟（UICC）指南对化疗反应进行临床和病理评估。
新辅助化疗后，10%的病例（4/40）出现完全临床缓解（cCR），30%的患者（12/40）出现部分缓解，60%（24/40）病情稳定。20%的患者（8/40）观察到病理完全缓解（pCR），无存活肿瘤证据。15例患者（37.5%）出现部分缓解，42.5%的患者（17/40）病情稳定。化疗过程中无患者病情进展。化疗后观察到肿瘤类型发生变化，最常见的是黏液样改变。新辅助化疗后常见的组织学变化包括细胞黏附丧失、肿瘤细胞萎缩、弹性组织变性、胶原化、坏死、淋巴细胞反应、巨细胞反应等。
新辅助化疗反应的病理评估比临床反应是更好的预测指标。可根据新辅助化疗1至2个周期后的反应调整化疗药物，反应基于肿瘤和患者的反应性。
