Comparison of Doxorubicin Plus Docetaxel Neoadjuvant Chemotherapy with Doxorubicin Plus Vinorelbine in Primary Breast Cancer / 한국유방암학회지

PURPOSE: This study was performed to compare the therapeutic efficacy and toxicity of doxorubicin plus docetaxel neoadjuvant chemotherapy (NC) with doxorubicin plus vinorelbine NC. METHODS: Fifty-three patients underwent 4 cycles of NC consisted of intravenous injection of doxorubicin (50 mg/m2) plus docetaxel (75 mg/m2) administered every 3 weeks (AD), while 49 patients underwent 4 cycles of NC consisted of intravenous injection of doxorubicin (50 mg/m2) and vinorelbine (25 mg/m2) administered every 3 weeks (AN). Response rate and treatment-related toxicities were analyzed by administered chemotherapeutics. Response to NC was also analyzed according to clinicobiological characteristics of the primary tumors. RESULTS: Clinical response was observed in 66% with AN and 81.6% with AD chemotherapy. A complete pathologic response (pCR) was confirmed in 6 patients (11.3%) with AN and in 7 patients (14.3%) with AD after the surgery. Response rate was significantly higher in AD compared with AN (p=0.038), but there was no significant difference between the two group regard to pCR rate. Breast conserving surgery (BCS) was performed in 35.8% of AN group, whereas 20 patients (40.8%) of AD group underwent BCS. The patients with HER2-amplified tumor showed significantly increased response to both types of NC. Pathologic complete response was confirmed in 9 (39.1%) out of 23 HER2-amplified tumors, whereas only 4 (5.1%) of 79 HER2-nonamplified tumors showed pathologic complete response. Febrile neutropenia occurred in 22.6% of total 212 cycles in AN and 38.8% of total 196 cycles in AD. Grade 3/4 neutropenia was observed in 39.6% in AN and 43.9% in AD. Grade 3 mucositis was observed in 26.4% with AN and in 40.8% with AD. CONCLUSION: There was no significant increase of pCR by AD compared with AN. Long-term follow-up results of our study indicate that clinical outcome after NC was significantly associated with initial response to NC regardless of therapeutic regimens.

Sentinel Lymph Node Biopsy in Patients with Clinically Negative Lymph Node After Neoadjuvant Chemotherapy / 한국유방암학회지

PURPOSE: We wanted to evaluate the accuracy of sentinel lymph node biopsy (SLNB) in patients with clinically negative lymph node after neoadjuvant chemotherapy. METHODS: Fifty-nine women underwent 4 cycles of neoadjuvant chemotherapy with epirubicin (75 mg/m2) plus docetaxel (75 mg/m2), or with doxorubicin (50 mg/m2), cyclophosphamide (600 mg/m2) and 5-fluorouracil (500 mg/m2) for their primary breast cancer. Their median age was 41 yr (range: 29-62) and all the tumors were larger than 3 cm in maximum diameter. SLNB was performed 3 min after periareolar injection of 1% isosulfan blue dye. All the patients underwent lymph node dissection at the level 1 and 2 axillary areas irrespective of their nodal status. RESULTS: A clinical response after neoadjuvant chemotherapy was observed in 46 patients (88%) and 11 (18.7%) patients had a complete pathologic response. Thirty-five patients (62.7%) underwent breast conserving surgery. The sentinel lymph node was identified in 96.6% and the median number of sentinel nodes was 3 (range: 1-6). The median number of dissected nodes was 14 (range: 11-47). Metastasis to the lymph node was observed in 56% of the patients. The sentinel lymph node was the only metastatic node in 12 patients. Three patients with a negative sentinel lymph node were confirmed to have metastasis to non-sentinel nodes after the final histologic examination (false negative rate: 9.1%). The overall accuracy of SLNB was 94.7%. CONCLUSION: SLNB after neoadjuvant chemotherapy was a safe method in patients with clinically negative lymph node.