2008 Annual Meeting Abstracts
Neoadjuvant Chemotherapy for Primary Breast Cancer: a Ten Year Institutional Experience
Hong Jun, MD, John C. Russell, M.D., Charles Wiggins, MD, Huining Kang, PhD.
University of New Mexico, Albuquerque, NM, USA.
Objective: Evaluate impact of neoadjuvant chemotherapy on surgical management of primary breast cancer
Design: Retrospective chart review
Setting: University Teaching Hospital
Patients: Female patients receiving chemotherapy prior to surgery for primary breast cancer
Interventions: Mastectomy or lumpectony with axillary node sampling or dissection
Main Outcome Measures: Clinical and pathologic response of primary tumor, presence of axillary lymph node metastases in surigcal specimen, rates of lumpectomy and mastectomy
Results: 1129 total breast cancer patients, 129 received neadjuvant chemotherapy (11.4%); 64 with sufficient data to evaluate (5.7%). Partial clinical response in 47 patients (73%), complete clinical response in 17 patients (26%) and complete pathologic response in 6 patients (9.4%). There were 2 (5%) complete pathologic responses in the mastectomy group, versus 4 (17%) complete pathologic responses in the lumpectomy group. 40 patients (63%) underwent mastectomy, 24 (37%) underwent lumpectomy. Of the patients undergoing mastectomy, 26 (65%) had positive axillary lymph nodes, while of 24 patients undergoing lumpectomy, only 5 (21%) had positive axillary lymph nodes (all less than 4 positive lymph nodes). The incidence of positive axillary lymph nodes correlated more closely with post chemotherapy clinical and pathologic tumor size, rather than pre chemotherapy clinical tumor size, suggesting axillary down-staging in response to chemotherapy.
Conclusions: The response of primary breast cancer to neoadjuvant chemotherapy was similar to large published series. However, despite signifcant reductions in primary tumor volumes with neoadjuvant chemotherapy (even in T3 lesions), a minority of patients underwent lumpectomy (37%, compared to 61% in NSABP B-27). Whether this represents patient or physician treatment preference remains to be determined.