Neoadjuvant chemotherapy for locally advanced breast cancer: Clinical and radiological response as predictors of local recurrence

S. A. McIntosh*, K. N. Ogston, I. D. Miller, S. Payne, A. W. Hutcheon, T. Sarkar, S. D. Heys

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Neoadjuvant chemotherapy is increasingly used to treat patients with large and locally advanced breast cancer. Neoadjuvant chemotherapy has been shown to reduce mastectomy rates and increase the number of patients suitable for breast conserving surgery. Little is known about local recurrence (LR) following breast conserving surgery in these patients. This study aimed to examine one centre's experience of LR rates following chemotherapy and surgery, and to assess factors predicting for LR. A total of 173 consecutive patients received neoadjuvant chemotherapy with 4-6 cycles of cyelophosphamide, vincristine, doxorubicin and prednisolone in 3-weekly cycles. Clinical and radiological responses were assessed following chemotherapy, and treatment was followed by surgery in the form of either mastectomy (73%) or lumpectomy (27%) and axillary node sampling. At a median follow-up of 62 months, LR was seen in 10 cases (6%) of those patients treated surgically. LR was seen in 1 of 44 (2.3%) of patients who underwent breast conserving surgery, 6 of 115 (5.2%) patients who underwent mastectomy, and 3 of 6 (50%) patients who underwent mastectomy with latissimus dorsi flap reconstruction (p<0.01). Initial clinical T or N stage did not predict the development of LR. Clinical and radiological response predicted for LR (p<0.01), with patients with stasis or progression of disease more likely to develop recurrence. Patients with histologically positive nodes were significantly more likely to develop LR, with only one LR occurring in a node-negative patient (p<0.01). Tumour grade did not influence the development of LR. Pathological response to chemotherapy did not predict for LR, although no recurrences were seen in patients with a complete response to chemotherapy. The use of adjuvant radiology did not significantly affect the development of LR. Extent of clinical and radiological response to neoadjuvant chemotherapy and pathological status nodal status may be useful in identifying patients at risk of developing LR following neoadjuvant chemotherapy.

Original languageEnglish
Number of pages1
JournalBreast Cancer Research and Treatment
Volume69
Issue number3
Publication statusPublished - 01 Dec 2001
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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