Predicting Prognosis and Neoadjuvant Chemotherapy Response in Carcinoma Breast: A Prospective Cohort Study

Abstract

Background: Objective : The objectives of this study were to evaluate and quantify the response to neo-adjuvant chemotherapy by physical examination and imaging modalities. Design : This was a prospective cohort study. Duration : 2 years and four months i.e. from March 2012 to September 2014. Setting: This study was conducted at Department of Surgery, KAPV Government Medical College and Hospital, Tiruchirapalli. Participants : 30 patients with stage III breast carcinoma who were admitted at Department of Surgery, KAPV Government Medical College and Hospital. Methods : Confirmation of diagnosis was done by FNAC/Biopsy of breast lump. Accurate measurement of breast lump was done in each patient. The patients received neoadjuvant chemotherapy (CAF regimen). Size, number and fixity of affected lymph nodes was also recorded before and after chemotherapy. The data thus collected was analysed, significance determined and the literature available was reviewed. Results : Out of 30 patients who received neoadjuvant chemotherapy with CAF, 76.6% of them underwent down staging of tumor by one or more stages. No patient showed complete clinical resolution. 16.6% patients had <25% reduction in size of tumor, 30% patients had 25-50% size reduction, 20% patients had up to 75% size reduction and 33.3% patients had up to 99% of size reduction. All patients had palpable axillary lymph nodes, out of which, 40% showed clinical resolution, while 60% showed a change in size but not change in stage. All the patients underwent surgery. Conclusion : benefit from tumor down staging can be achieved by neo-adjuvant chemotherapy and it is the preferred approach for patients with bulky and locally advanced disease at the time of diagnosis.