Abstract
Background: NACT is being increasingly employed to deal with breast malignancies. It is important to know the predictive value of various morphological parameters for the pathological complete response. It is also interesting to note the various changes that happen to tumor bed due to chemotherapy.
Aims and Objectives: 1)To evaluate the importance of various morphological parameters in predicting response to NACT 2)To observe histological changes in the tumor bed after NACT.
Materials and Methods: A total of 108 cases where NACT was given were selected over a 3 year old period and clinical and histological parameters were assessed prior to and after NACT.
Results: The statistical significance for the association of various parameters is calculated and it was found that age has no influence on response to NACT where as morphological subtype, size of the tumor, grade of the tumor before NACT, Lymph node status after NACT, DCIS, tumor lymphocytic response were all found to be associated statistically with complete pathological response. Fibrosis and necrosis were the common changes that happen to the tumor bed due to chemotherapy
Conclusions: Even in the current era of molecular pathology, basic morphological parameters still play a pivotal role in selecting the patients for NACT.
Keywords: NACT (Neo adjuvant chemotherapy), PCR (Pathological complete response), NOS (Not otherwise specified),RCB(Residual cancer burden).
References
- Ferlay J, Colombet M, Soerjomataram I et al. Global and Regional Estimates of the Incidence and Mortality for 38 Cancers: GLOBOCAN 2018. Lyon: International Agency for Research on Cancer/World Health Organization; 2018.
- Gupta A, Shridhar K, Dhillon PK. A review of breast cancerawareness among women in India: cancer literate or aware-ness deficit? Eur J Cancer 2015; 51: 2058–66
- Outcome of neoadjuvant chemotherapy in locally advanced breast cancer: A tertiary care centre experience: Tapesh Bhattacharyya, Suresh C Sharma, Budhi Singh Yadav, Rajinder Singh, Gurpreet Singh Indian J Med Paediatr Oncol. 2014 Jul-Sep; 35(3): 215–2204)
- Bonnefoi, H & Litière, Saskia & Piccart, Martine & Macgrogan,. Pathological complete response after neoadjuvant chemotherapy is an independent predictive factor irrespective of simplified breast cancer intrinsic subtypes: A landmark and two-step approach analyses from the EORTC 10994/BIG 1-00 phase III trial. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. 25. 10.1093/annonc/mdu118.
- https://cap.objects.frb.io/protocols/cp-breast-invasive-18protocol-4100.pdf
- Ogston KN, Miller D, Payne S, et al. A newhistological grading system to assess response ofbreast cancers to primary chemotherapy: prognosticsignificance and survival. Breast. 2003; 12: 320-7
- Symmans WF, Peintinger F, Hatzis C, Rajan R, Kuerer H, Valero V, Assad L, Poniecka A, Hennessy B, Green M, Buzdar AU, Singletary SE, Hortobagyi GN, Pusztai L. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2007;25:4414–4422
- van der Wall E, Rutgers EJ, Holtkamp MJ, Baars JW, Schornagel JH, Peterse JL, Beijnen JH, Rodenhuis S. Efficacy of up-front 5-fluorouracil-epidoxorubicin-cyclophosphamide (FEC) chemotherapy with an increased dose of epidoxorubicin in high-risk breast cancer patients. Br J Cancer 1996; 73 (9): 1080–5
- Burcombe RJ, Makris A, Richman PI, Daley FM, Noble S, Pittam M, Wright D, Allen SA, Dove J, Wilson GD. Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvantanthracycline chemotherapy for operable breast cancer. Br J Cancer 2005; 92 (1): 147–55.
- Moon YW, Rha SY, Jeung HC, Yang WI, Suh CO, Chung HC. Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol 2005; 16 (11): 1778–85.
- Sethi D, Sen R, Parshad S, Khetarpal S, Garg M, Sen J. Histopathologic changes following neoadjuvant chemotherapy in locally advanced breast cancer. Indian J Cancer 2013; 50 (1): 58–64.
- Gharbi O, Trabelsi A, Chafai R, Zayen A, Ezzair F, Hochlef M etal.Clinical and pathological response to neoadjuvantan-thracycline based chemotherapy in women with breast cancer World J oncol 2010;1:167-7213)
- M. Fayanju, I. Nwaogu, D. Jeffe, and J.Margenthaler, “Pathological complete response in breast cancer patients following neoadjuvant chemotherapy at a Comprehensive Cancer Center: the natural history of an elusive prognosticator,” Molecular and Clinical Oncology, vol. 3, no. 4, pp. 775–780, 2015.
- Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status and survival in 24,740 breast cancer cases. Cancer 1989;63:181–187
- Rosen PP, Groshen S, Kinne DW et al. Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J ClinOncol 1993;11:2090–2100. Abstract/FREE Full Text
- Fisher B, Slack NH, Bross ID et al. Cancer of the breast: size of neoplasm and prognosis. Cancer 1969;24:1071–1080
- Tewari M, Pradhan S, Singh U, Singh TB, Shukla HS: Assessment of predictive markers of response to neoadjuvant chemotherapy in breast cancer.Asian J surg 2010,33(4):157-67
- Pu RT, Schott AF, Sturtz DE, Griffith KA, Kleer CG. Pathological features of breast cancer associated with complete response to neoadjuvant chemotherapy: importance of tumor necrosis. Am J surg Pathol 2005:29:354-58
- Carsten Denkert, Sibylle Liobletal Tumor associated lymphocytes as an independent predictor of response to NACT in breast cancer, J clinoncol 28(1)105-113,2010
- Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Moliterni A, Terenziani M and Zambetti M (1998) Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J ClinOncol 16: 93–100
- Cameron DA, Anderson ED, Levack P, Hawkins RA, Anderson TJ, Leonard RC, Forrest AP and Chetty U (1997) Primary systemic therapy for operable breast cancer – 10-year survival data after chemotherapy and hormone therapy. Br J Cancer 76: 1099–1105
- R. Fisher, J. Wang, J. Bryant, B. Fisher, E. Mamounas, and N.Wolmark, “Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-18,” Cancer, vol. 95, no. 4, pp. 681– 695, 2002
- Jones RL, Lakhani SR, Ring AE etal Pathological complete response and residual DCIS following NACT for breast carcinoma Br J cancer 2006 Feb 13;94(3):358-62
- Moreno A, Escobedo A, Benito E, Serra JM, Guma A, Riu F. Pathological changes related to CMF primary chemotherapy in breast cancer. Pathological evaluation of response predicts clinical outcome Breast cancer Res Treat 2002,75:119-25.
- Hasebe T, Tsuda H, Hirohashi S, Shimosato Y, Tsubono Y, Yamamoto H etal Fibrotic focus in infiltrating duct cell carcinoma of the breast :A significant histopathologicalparameterfor predicting the long term survival of the patients. Breast cancer Res Treat 1998;49:195-208.
Corresponding Author
Nambiar Ajit MD, DNB, FRCPath
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