No. 5, OPD Blocks, Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Banglore, 560029, Karnataka, India,
J Cancer Res Clin Oncol. 2014 Oct;140(10):1777-82. doi: 10.1007/s00432-014-1724-1. Epub 2014 Jun 4.
Preoperative or neoadjuvant chemotherapy is an option in patients with large operable breast cancer to facilitate the breast conservation and to downstage the disease to make inoperable breast cancer to operable one. It is also called the window of opportunity; it provides a unique opportunity to derive biological information related to tumor response. Neoadjuvant chemotherapy has been compared with standard, postoperative adjuvant chemotherapy with goals of improving survival and facilitating local therapies. Unfortunately, neoadjuvant chemotherapy does not seem to improve overall survival. There is a lack of data from India regarding the neoadjuvant chemotherapy. The present study was carried out to assess the response to neoadjuvant chemotherapy in breast cancer.
We retrospectively analyzed the records of patients who were started on neoadjuvant chemotherapy (NACT) at our center for 1 year (August 2012 to July 2013). Case files were thoroughly reviewed, and patient's characteristics (age, pre-/postmenopausal status, family history of breast/ovarian/other cancer), mode of detection, treatment, and histological features were analyzed.
Out of 322 patients with breast cancer registered in our institute, 80 patients received neoadjuvant chemotherapy. Median age was 45 years. The most common presentation was left-sided breast lump (Lt > Rt) with a median duration of symptoms was 4 months. Postmenopausal patients (53.75 %) were more than premenopausal (46.25 %). Seventy-two patients were stage III and 8 were stage II disease. Bilateral breast cancer was seen in 8 patients. Most common histological type was invasive ductal carcinoma (95 %). Estrogen receptor (ER) and/or progesterone (PR) positive were seen in 47 (58.75 %) patients. Ten patients were HER2 positive and ER/PR negative, and 5 patients were triple positive. Triple-negative patients were 22 (27.5 %). The most common neoadjuvant chemotherapy protocol used was FEC. Clinical response before surgery was CR 13 %, PR 68.68 %, stable disease 11.62 %, and progressive disease 4.65 %. Pathological CR was seen in 6.9 % of tumors. Nodal status at surgery was ypN0-40 %, ypN1-28. 5 %. ypN2-27 %, and ypN3-4.28 %.
In a population of predominantly locally advanced patients, NACT with anthracyclines yielded pCR rates comparable to published studies. There were a high proportion of HER2-positive patients, most of whom could not receive anti-HER2 therapy due to financial reasons.
对于可手术的大型乳腺癌患者，术前或新辅助化疗是一种选择，以促进保乳并降低疾病分期，使不可手术的乳腺癌变为可手术的乳腺癌。它也被称为机会之窗；它提供了获取与肿瘤反应相关的生物学信息的独特机会。新辅助化疗已与标准的术后辅助化疗进行了比较，其目标是提高生存率并促进局部治疗。不幸的是，新辅助化疗似乎并不能提高总生存率。印度缺乏关于新辅助化疗的数据。本研究旨在评估乳腺癌新辅助化疗的反应。
我们对我院接受新辅助化疗（NACT）治疗的患者的记录进行了回顾性分析，时间为 1 年（2012 年 8 月至 2013 年 7 月）。彻底审查了病历，分析了患者的特征（年龄、绝经前/后状态、乳腺癌/卵巢癌/其他癌症的家族史）、检测方式、治疗和组织学特征。
在我院登记的 322 例乳腺癌患者中，80 例接受了新辅助化疗。中位年龄为 45 岁。最常见的表现是左侧乳房肿块（Lt > Rt），中位症状持续时间为 4 个月。绝经后患者（53.75%）多于绝经前患者（46.25%）。72 例患者为 III 期，8 例为 II 期疾病。8 例患者双侧乳腺癌。最常见的组织学类型是浸润性导管癌（95%）。雌激素受体（ER）和/或孕激素（PR）阳性者 47 例（58.75%）。10 例患者 HER2 阳性，ER/PR 阴性，5 例患者三阳性。三阴性患者 22 例（27.5%）。最常用的新辅助化疗方案是 FEC。术前临床缓解率为 CR13%，PR68.68%，稳定疾病 11.62%，进展性疾病 4.65%。肿瘤病理完全缓解率为 6.9%。手术时的淋巴结状态为ypN0-40%，ypN1-28.5%，ypN2-27%，ypN3-4.28%。
在以局部晚期患者为主的人群中，蒽环类药物的新辅助化疗产生的 pCR 率与已发表的研究相当。HER2 阳性患者比例较高，其中大多数因经济原因无法接受抗 HER2 治疗。
