Analysis of pathological response after neoadjuvant chemoradiation in Stage III Breast Cancer.

Sivakumar, M (2014) Analysis of pathological response after neoadjuvant chemoradiation in Stage III Breast Cancer. Masters thesis, Cancer Institute (WIA), Chennai.


Download (2MB) | Preview


BACKGROUND : Locally advanced Breast cancer (LABC) is a heterogenous group of tumors with marked variation in outcome and high propensity for local, regional and distant failure. Hence integrated multimodality approach had become standard for optimal patient outcome. Neoadjuvant chemotherapy has evolved as the conventional and standard of care in treatment of LABC. Neoadjuvant chemoradiation is also a safe and valid multimodality treatment option for LABC. Neoadjuvant chemotherapy is established as standard treatment for LABC with varying pathological response rate. There is significant association between the extent of pathological response and longterm outcome in terms of disease free survival- DFS and overall survival-OS. Neoadjuvant chemoradiation is associated with higher pathological response rate that translate in terms of survival benefit. Shanta V, et al analysed one of the largest database containing 1,117 LABC patients treated with neoadjuvant concurrent chemoradiation during 1990 to 1999. The reported clinical response rate was 91 % and complete pathological response rate up to 33.7 %. Patients with complete pathological response rate had long term survival. The DFS at 5, 10 and 15 years was 76.6%,69.6% and 63.6% respectively. The corresponding overall survival was 86.5%, 78% and 76.2%. AIMS : 1. To analyse the pathological response rate following neoadjuvant chemoradiation in stage III breast cancer. 2. To study the outcomes in terms of disease free survival and overall survival. 3. To determine the clinicopathological factors associated with pathological response and survival outcomes. MATERIALS AND METHODS : Previously untreated biopsy and cytology proven 831 stage III breast cancer patients treated at our institute between 2006 and 2008 with neoadjuvant concurrent chemoradiation were taken and 550 patients who had surgery after the neoadjuvant concurrent chemoradiation protocol were included in the study for analysis. All patients were clinically staged by IUCC- TNM 2002 classification system, Stage III (A, B, C). CONCLUSION : Multimodality treatment strategy has been established as a standard of care for locally advanced breast cancer. Neoadjuvant chemotherapy protocol was standardised as the conventional approach worldwide with improved long term outcomes. At our institute, we are practicing multimodality approach for breast cancer since 1960. Our treatment policy of preoperative concurrent chemoradiation was a uniform protocol.It had consistently showed improved outcomes for locally advanced breast cancer, from the present study and previous published studies from our institute. All 550 patients treated with this protocol tolerated the treatment well without any treatment related mortality. The morbidities reported in our study were manageable. The pathological complete response achieved in our study was 25% comparable with 12% to 39 % reported in the literature for neoadjuvant concurrent chemoradiation protocol, considering the fact that majority in our study received anthracyclin containing regimen without taxanes. The clinicopathological and treatment factor like receptor status ER/PR, grade of the tumor and the chemotherapy regimen had a statistically significant association with the pathological response rate. The number of chemotherapy cycles received before surgery had no statistical impact on the pCR. The five year DFS and OS was 69% and 72% respectively which was a better survival outcome for stage III breast cancer compared to world standards. Also the local and loco regional failure rates are lower in our study group than that reported in the literature. Complete pathological response is a reliable surrogate marker of survival outcomes. Locally advanced breast cancer patients who are already at high risk for local and distant failure can have favourable long term survival outcomes by achieving pCR with the multimodality treatment approach.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Analysis of pathological response after neoadjuvant chemoradiation in Stage III Breast Cancer.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:50
Last Modified: 26 Jul 2017 02:50

Actions (login required)

View Item View Item