Breast conserving treatment after neoadjuvant chemotherapy for Ⅱ and Ⅲ stage breast cancer / 解放军医学杂志

ABSTRACT

Objective To investigate the feasibility of breast conserving surgery after neoadjuvant chemotherapy for Ⅱ and Ⅲ stage breast cancer.Methods Forty-six patients,suffering from Ⅱ and Ⅲ stage breast cancer admitted to 309 Hospital of PLA from Jun.2003 to Dec.2008,and received breast conserving surgery after neoadjuvant chemotherapy,were followed-up.Chemotherapy protocol included intravenous injection of epirubicin 60mg/m2 on day 1 and continuous intravenous infusion of paclitaxel 150 mg/m2 for 3 hours on day 2.The neoadjuvant chemotherapy was repeated every 21 days for 2-4 cycles.Patients eligible for breast conserving therapy received quadrantectomy or wide excision of tumor plus axillary lymph node resection.Evidence of local recurrence and distant metastasis and breast contour were followed up after surgery.Results After neoadjuvant chemotherapy,9 patients showed complete clinical response(CR),37 patients showed partial response(PR).Post-operative pathological examination showed that there were varied degrees of apomorphosis and necrosis of tumor cells,interstitial edema,fibrous hyperplasia,and inflammatory cell infiltration,among them pathological remission was found in 4 cases.The patients were followed up for 8 to 70 months with a mean of 58 months,local recurrence was found in 4 cases distant metastasis was found in 3 patients,and 2 of them died.Assessment of breast contour was carried out in 31 cases 1 year after breast conserving therapy,and excellent results were obtained in 6 cases,good in 18 cases and poor in 7 cases.Conclusions It is safe for patients with Ⅱ-Ⅲ stage breast cancer to receive preoperatively treatment with neoadjuvant chemotherapy.Routine operation,postoperative irradiation and chemotherapy and systemic support are the keys to achieve satisfactory result of breast conserving therapy.