RESUMEN
This study aimed to evaluate the efficacy and toxicity of neoadjuvant chemotherapy [NCT] with docetaxel/epirubicin combination in patients with locally advanced breast carcinoma. In addition, to stratify the pathological response to chemotherapy according to a proposed grading system of response. Between July 2000 till December 2002, 24 patients with locally advanced breast carcinoma were recruited and completed their treatment with neoadjuvant chemotherapy, followed by surgery, adjuvant chemotherapy and radiotherapy +/- tamoxifen; following a proposed regimen. Clinical and pathological results of neoadjuvant chemotherapy were evaluated. The patients' median age was 50 years, 54.2% were postmenopausal and all patients had stage III disease with minimum T3 tumour. Clinically positive axilla was detected in 70.8% of patients and 91.7% had infiltrating duct carcinoma. Patients were treated with 4 cycles of NCT formed of epirubicin 90 mg/m2/i.v plus docetaxel 75 mg/m2, one-hour infusion on day one, repeated every 3 weeks upon full marrow recovery. The post treatment clinical assessment revealed that 6 patients [25%] showed clinical complete response, 70.8% achieved clinical partial response [overall response rate 95.8%] with significant reduction of the tumour and axillary nodes dimension. Twenty-two patients underwent surgical interference [10 conservative resection and 12 modified radical mastectomy]. Pathological assessment of the specimen showed that the objective pathological response of breast lesion was 59.1% with 18.2% pathological complete response [Grade 5]. Similarly pathological complete response of axillary involved lymph nodes [Grade D] was achieved in 50% of patients. The clinical and pathological responses were significantly higher for patients with negative hormone receptors. Grade 3 and 4 neutropenia were the major side effect encountered in 79.2% of patients during NCT phase. Patients were followed up for a median of 15 months, the median disease free survival [DFS] was 15 months and the median overall survival [OAS] was not reached. The estimated 2-year DFS was 70% and 2-year OAS was 84%. It was concluded that this regimen of NCT proved to be efficient for treatment of locally advanced breast cancer in terms of clinical, pathological responses as well as the rate of conservative surgery that could be achieved. The pathologic grading of response may be useful for selection criteria of the subset of patients that could benefit from maximizing adjuvant chemotherapy. Future trials should incorporate growth factor support in the treatment regimen to avoid undue toxicity