Neoadjuvant concurrent chemoradiation (CTRT) is not widely practised in breast cancer. We present our experience with the use of neoadjuvant CTRT in patients with locally advanced breast cancers (LABC) treated at our centre.
The study included all consecutive female patients with inoperable stage III LABC treated at our centre from December 2015 to June 2016. Data were collected retrospectively from the patients’ case records. The impact of neoadjuvant CTRT on pathological complete response and survival was analysed. All patients received 2 cycles of Paclitaxel 3 weekly (175 mg/m2/dose) with External beam radiotherapy (EBRT) delivered at 46 Gy in 23 fractions given over 5 weeks.
The study included 100 patients with a median age of 49 years among whom 9/100 (9%) had IIIA disease, 73/100 (73%) IIIB and 18/100 (18%) had IIIC disease. Hormone receptor-positive disease was observed in 36/100 (36%) patients, triple negative in 24/100 (24%) and Her2 neu positive disease in 40/100 (40%) patients. All patients were operable after completing the planned neoadjuvant treatments. Ninety-one out of 100 (91%) patients underwent modified radical mastectomy whereas 9/100 (9%) did not consent for surgery. pCR was observed in 12/21 (57.1%) patients with triple-negative disease, 11/34 (32.3%) patients with hormone receptor-positive disease and 16/36 (44.4%) patients with Her2 neu positive disease. Most common morbidity observed was grade 3 skin reactions. No grade 4 skin toxicity was observed. The 2-year event-free survival (EFS) and overall survival (OS) for the entire cohort was 88 % and 73.1 % respectively.
Neoadjuvant CTRT is well tolerated and is associated with higher pCR rates than what has been reported with neoadjuvant chemotherapy alone. However, further prospective studies with longer follow-up are required to confirm our findings.
Cancer Institute, Chennai, India.
Has not received any funding.
All authors have declared no conflicts of interest.