Correlation between Tumor Response to Neoadjuvant Chemotherapy and Patient Outcome in Breast Cancer

Kim, Je Ryong; Park, Hye Duck; Chang, Eil Sung

Abstract

PURPOSE: Neoadjuvant chemotherapy is being used increasingly in the treatment of patients with large or locally advanced breast cancer with the aims of downstaging and eliminating micrometastasis. We report a correlation between tumor response to preoperative primary chemotherapy and patient outcome in a series of 73 consecutive patients with breast cancer. METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancer (tumor size>3 cm or clinically axillary node positive) were treated with multimodality therapy, including a sandwich type of chemotherapy, comprised of 3 preoperative cycles and 3 postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months.
RESULTS
The overall objective clinical response rate (complete & partial response) of the primary tumor to chemotherapy was 75.5% (standard UICC criteria). The pathologic complete response rate was 9.6%. The overall 5-year survival rate was 86.8%, and the overall 5-year disease free survival rate was 82.6%. The response rate to chemotherapy declined with increasing tumor size, but there was no relationship between the clinical response to chemotherapy and menopausal status, chemotherapeutic regimen, or histopathologic type. A breast-conserving operation could be done in 64.4% of the patients as a result of a decrease in the tumor size. CONCLUSION: Neoadjuvant chemotherapy allows a breast-conserving operation to be performed more frequently in cases of large or locally advanced breast cancer. The responses to neoadjuvant chemotherapy is a powerful prognostic factor for the overall survival and the disease free survival in breast cancer patients.