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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 1  |  Page : 16-21

Role of Neoadjuvant Chemotherapy in Large Operable Breast Cancers: A Prospective Nonrandomized Study


1 Department of Surgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, India
2 Department of Pathology, MIMER Medical College, Pune, India
3 Department of Surgery, Dr. GSMC College, Mumbai, Mahrashtra, India

Correspondence Address:
Kshitij Arun Manerikar
Department of Surgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_176_17

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Introduction: Breast cancer is the most common cancer in females worldwide. The presentations of breast cancer patients are varied, and available treatment options are many. Management of breast cancer has changed over the period of years from radical surgeries to more of conservative approaches. The present study was undertaken to evaluate the role of neoadjuvant chemotherapy therapy in downstaging large operable breast cancer (LOBC) in the Indian population and usefulness of less radical, breast conservative surgery (BCS) in these patients. Materials and Methods: A prospective nonrandomized study of 32 patients with LOBC was carried out between September 2014 and August 2015. Patients with stage IIIA disease of 18–70 years of age were included. Clinical tumor response was graded according to the World Health Organization Criteria for clinical tumor response. Locoregional management consisted of either BCS (wide local excision, complete axillary dissection, postoperative radiotherapy) or modified radical mastectomy (MRM), depending on feasibility for BCS and patients' choice about the type of surgery to undergo. Data collected was documented and analyzed. Results: The mean age of patients was 43.73 years. Most of the patients were premenopausal. About 75% of patients achieved maximal response after 4 cycles neoadjuvant chemotherapy. Statistically significant response was achieved in downstaging the breast cancer. Complete clinical response was seen in 12.5%, and partial clinical response (cPR) was seen in 75% patients after neoadjuvant systematic chemotherapy. Postneoadjuvant chemotherapy, 68.75% patients became feasible for BCS. There was no statistically significant association between age, initial tumor size, and menstrual status with tumor response to chemotherapy and feasibility for BCS. Conclusions: To conclude, Neoadjuvant Systemic Therapy is effective in the management of LOBC. BCS is feasible in the majority of LOBC after downstaging by Neoadjuvant Systemic Therapy, which otherwise would require MRM.


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