A multicenter retrospective study of neoadjuvant chemotherapy and breast conservation rate in locally advanced breast cancer.

backgroundThe burden of locally advanced breast cancer is increasing in low-middle income countries (LMIC) with major impact on the women’s quality of life (QOL). We aimed to assess the impact of neoadjuvant therapy on the rate of conversion of breast surgery from mastectomy to conservation. PATIENTS AND

methodsWe conducted a retrospective study on files of patients diagnosed with locally advanced breast cancer (clinical stage IIB to IIIC) in 2 academic hospitals between January 2016 and December 2020 who are eligible for neoadjuvant therapy as per tumor size and\or lymph node involvement. The study was approved by the IRB and all patients signed informed consent form.

resultsA total of 103 consecutive patients were eligible with a mean age of 48 years and 26.2% of them younger than 40 years. The majority (87.4%) presented with clinical stage III, 45% were luminal A-like subtype. After neoadjuvant therapy, 100 patients had surgery, among which 47 patients (47%) could attain breast conservation and 35% achieved pathological complete remission (PCR). Breast conservation could be more commonly achieved in patients < 40 years (p = 0.05), those with lower clinical stage (p < 0.001) and those with higher KI67 (p = 0.017). PCR was more common in high KI67 (p = 0.016), and HER2-positive tumors (p = 0.003). After a relatively short follow-up, the3-year DFS rate for all study group was 65.9% with a superior 3 year DFS rate in patients who had BCS (78% vs. 56.3% in MRM group); p = 0.04.

conclusionEven in limited resources setting, neoadjuvant therapy has a valuable role in downstaging and breast conservation highlighting its importance as a cornerstone management in high risk non metastatic breast cancer patients. QOL could be an advantage though it was not directly assessed.