The response, operability, and type of surgery following neoadjuvant chemotherapy in Sudanese patients with locally advanced breast cancer

Abstract

Background: Neoadjuvant chemotherapy (NACT) treatment has become the standard treatment for locally advanced breast cancer (LABC) in many centers worldwide.

Objectives: This study evaluates the short-term response of patients with LABC to NACT and its impact on operability and the type of surgery.

Patients and Methods: This is a descriptive analytical hospital-based study including 147 patients with LABC who were presented to Plastic and Reconstructive Surgery Unit at Soba University hospital (SUH), between January 2012 and December 2014, and were treated with NACT. Clinical and pathological responses to neoadjuvant chemotherapy were evaluated according to Union for International Cancer Control criteria, operability, and the type of surgery performed was also recorded.

Results: All patients were females, the mean age was 43 ± 7 years, of them 53.7% were pre-menopausal, 51% presented with a breast lump, 19.7% with nipple discharge, and 19% with skin changes and ulceration. The mean initial tumor size was 7 cm ± SD. Following NACT, complete clinical response was reported in 30 patients (20.4%), partial clinical response in 92(62.6%), stable clinical response in 20 (13.6%), and five (3.4%) had progressive clinical response. Initial smaller tumors (size < 5 cm) showed a better clinical response to NACT as 76.7% of complete clinical response was achieved. Pathological complete response was achieved in 25(17%) patients, pathological partial response in 102(74.1%), and pathological stable disease in 13(8.8%). Following NACT, breast conserving surgery was performed in 78(53.1%) patients, Modified Radical Mastectomy in 64(43.5%), 25 of them had Latissimus Dorsi, and five patients were not offered surgery as they developed progressive disease during the study period.

Conclusion: Following NACT, it was possible to perform surgery in more than 96% of patients with LABC.

Keywords: locally advanced breast cancer, neoadjuvant chemotherapy treatment, clinical response, pathological complete response, operability