چکیده (انگلیسی):

Context: Local recurrence is a formidable risk consideration in employing breast conservation for breast
cancer. However pathological complete regression (PCR) from chemotherapy has been associated with
improved rates of recurrence. Lower PCR rates have been reported from earlier studies and our approach
seeks to obtain higher PCR rates utilizing a two pronged approach of surgery and chemotherapy.
Objective: To determine success rates in attaining pathologically complete regression for breast conservation
in non-metastatic breast cancer cases in a developing country and their clinical outcome.
Patients and methods: Patients diagnosed with early stage breast cancers had sequential anthracycline/
taxane based neoadjuvant/adjuvant chemotherapy administered at three weekly intervals. Following an
initial excision, re-excisions were done following three courses of doxorubicin based chemotherapy.
Subsequent re-excisions in cases with failed complete pathological regression were repeated following
additional three doxorubicin based chemotherapy cycles or at sequel third taxane based cycle. Endpoint
was pathologically complete regression as determined on permanent sections.
Results: Patients ages ranged between 27 and 67 years, mean age 43years, SD 10.34 years, N ¼ 20 Initial
breast tumour sizes ranged between 0.5 and 9 cm, mean 4.05 cm, SD 2.38. There were three T4, four T3
tumours, seven T2 and six T1 tumours. Clinical axillary lymphadenopathy with pathological involvement
was present in 11 cases. Histological diagnosis showed 13 cases of invasive ductal carcinoma (65.0%), 2
cases of ductal carcinoma insitu (10.0%), 1 papillary carcinoma (5.0%), 3 cases of invasive lobular carcinoma
(15.0%) and non-specific type 1 (5.0%). Immunohistochemistry assessment available in 15 cases
was positive for estrogen and progesterone receptors in 10 cases. Two cases (10.0%) exhibited 20%
positivity for human epidermal growth factor receptor. Pathological complete regression (PCR) defined as
no invasive or insitu tumour residuals in the excised tumour bed, was achieved in the 18 cases assessed.
(100%) This was consistent with clinical complete response obtained. It was not determined in 2 cases
though clinical complete response was obtained. PCR was determined in ten cases (50.0%) at the first
reexcision, second reexcision in 4 cases (20.0%) and third reexcision in 4 cases (20.0%). Mean no of reexcisions
1.67 cm, SD 0.84. Six sequential anthracycline/taxane cycles were administered in 17 cases
while three cases received anthracycline based chemotherapy only. Median duration of followup from
diagnosis was 48 months ranging between 8 months and 144 months. There were two demises at 48
months and 36 months follow up.
Conclusion: Extended chemotherapy sessions alongside re-excisions were successful in achieving much
enhanced rates of pathologically complete remissions at 100% in this yet early report, thus improving
breast conservation rates even for T3 and T4 tumours. Our study reports higher PCR rates.