Department of Medical Oncology, Palmerston North Hospital, Palmerston North, New Zealand.
Department of Medical Oncology, Hawke's Bay Hospital, Hastings, New Zealand.
Intern Med J. 2020 Mar;50(3):315-321. doi: 10.1111/imj.14326.
Neoadjuvant chemotherapy (NACT) is increasingly used for managing locally advanced and high risk non-metastatic breast cancer.
To describe trends in NACT use, assess compliance to best practice recommendations and determine treatment response rates in a regional cancer treatment service.
In this retrospective cross- sectional study, electronic records of patients who underwent NACT in centres covered by the MidCentral Regional Cancer Treatment Service in 2013 and 2017 were reviewed. Data pertaining to patient demographics, disease status, compliance to best practice recommendations and treatment outcomes were extracted and analysed.
Of a total of 502 referrals for non-metastatic breast cancer, 34 underwent NACT with the estimated NACT rate rising from 3.85% (2013) to 9.92% (2017). Compliance to practice recommendations improved in all domains (pre-treatment tumour and axillary evaluation, marker placement, multidisciplinary discussion). Overall, NACT was well tolerated with only three patients experiencing treatment limiting toxicity. Response rates mirror published data (complete response: 29.4%, partial: 61.8%) with higher responses registered in HER2 positive and triple negative subtypes. Discordance between radiological and pathological response was 28%, with imaging overestimating response in five out of seven cases. Of the 11 (32%) patients who initially underwent breast conserving surgery, six required a second surgery.
NACT is increasingly used in the Regional Cancer Treatment Service, with improving compliance to practice recommendations. These results are reassuring and can be used to help patients develop a realistic expectation towards NACT.
新辅助化疗（NACT）越来越多地用于治疗局部晚期和高危非转移性乳腺癌。
描述区域癌症治疗服务中新辅助化疗的使用趋势，评估其对最佳实践建议的依从性，并确定治疗反应率。
在这项回顾性的交叉研究中，对 2013 年和 2017 年在 MidCentral 区域癌症治疗服务覆盖的中心接受 NACT 的患者的电子病历进行了审查。提取并分析了与患者人口统计学、疾病状况、对最佳实践建议的依从性以及治疗结果相关的数据。
在总共 502 例非转移性乳腺癌的转诊中，有 34 例接受了 NACT，估计 NACT 率从 2013 年的 3.85%上升到 2017 年的 9.92%。所有领域（术前肿瘤和腋窝评估、标志物放置、多学科讨论）对实践建议的依从性都有所提高。总体而言，NACT 耐受性良好，只有 3 名患者出现治疗限制毒性。反应率与已发表的数据一致（完全缓解：29.4%，部分缓解：61.8%），HER2 阳性和三阴性亚型的反应更高。影像学和病理学反应之间的差异为 28%，在七种情况下有五种影像学结果高估了反应。在最初接受保乳手术的 11 名（32%）患者中，有 6 名需要进行第二次手术。
新辅助化疗在区域癌症治疗服务中越来越多地被使用，并且对实践建议的依从性也在提高。这些结果令人安心，可以帮助患者对新辅助化疗形成现实的期望。
