Neoadjuvant Chemotherapy Response Among Patients with Locally Advanced Breast Cancer at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia.
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Date
2020-10
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Addis Ababa University
Abstract
Background: Breast cancer is the leading cause of cancer death among females globally. In sub-Saharan African countries, a high proportion of breast cancers are locally advanced breast cancer (LABC) or metastatic at the time of diagnosis. LABC is primarily treated by neoadjuvant chemotherapy (NACT) before surgery. There is no data on response rate and resectability of LABC after NACT in Ethiopia.
Objective: The objective of this study is to assess the rate of clinicopathologic response and rate of resectability of LABC after NACT at Tikur Anbessa Specialized Hospital (TASH), Ethiopia.
Methods: This is a retrospective study which assesses response and resectability of LABC after NACT at TASH from September 2017 G.C to August 2019 G.C. Patients who were evaluated at breast multidisciplinary team (MDT) clinic by Breast surgeon and Oncologist and decided to receive upfront chemotherapy to downstage the tumor were included in this study. Patients were given 4 cycles of NACT with AC (doxorubicin + cyclophos phamide) or 8 cycles of NACT with AC – T (4 cycles of AC + 4 cycles of paclitaxel). After chemotherapy patients were revaluated at MDT for modified radical mastectomy (MRM). Data were collected from patient charts and
filled on, cleared for completeness, analyzed using SPSS 25 software.
Results: A total of 141 breast cancer patients were presented to the MDT. Of which 63 patients were decided to undergo upfront surgery and 78 patients to receive neoadjuvant therapy. Of the 78 patients who received neoadjuvant therapy only 51 patients were eligible for the study. The mean age of patients was 40.1 ± 9.96 SD years old (24-65). 11 patients (21.6 %) had complete clinical response (cCR), 31 patients (60.8 %) had clinical partial response (PR), 3 patients (5.9 %) had stable disease (SD) and 6 patients (11.8 %) had progressive disease (PD) after NACT. Forty-one patients (80.4 %) undergo mastectomy, 23 patients (56.1 %) had negative margins, 16 patients (39 %) had positive margins and in 2 patients (4.9 %) the surgical margin status was not mentioned. Only 4 patients (9.8 %) had complete pathologic response (pCR) after NACT. Patients who took AC – T (NACT) had a higher overall clinical response rate (p = 0.099) and cCR (p = 0.037) but not statistically significant compared to patients who took AC NACT. Older patients (> 50 years old) with LABC had higher complete pathologic response but not statistically significant after NACT during pathologic assessment compared to patients below the age of 50 years (p = 0.062).
Conclusion: The study has shown administering neoadjuvant chemotherapy either with AC or AC – T has decreased the tumor size significantly to make it resectable with a clear margin. AC – T had a slightly higher overall response rate and complete clinical response rate.
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Keywords
Neoadjuvant chemotherapy,breast cancer