A study of the assessment of pathological response to neoadjuvant chemotherapy in patients with breast cancer

Abstract: BACKGROUND: Neoadjuvant chemotherapy therapy ( NACT) has emerged as an integrated therapeutic approach to treat locally advanced breast cancer in order to down stage the tumour and to assess tumour response to chemotherapy. The aims of this study were to estimate the incidence of complete and partial pathological response in patients undergoing NACT for breast cancer and to evaluate the clinico pathological parameters associated with pathological response. MATERIALS AND METHODS: The study included breast cancer specimens from patients who had received NACT. The pathological response to NACT was assessed by the AJCC protocol and the morphological features associated with NACT were recorded. The clinicopathological parameters associated with complete pathological response were also studied. The association between the clinicopathological paramaters and pathological response was studies using Chi square and Fisher exact tests. RESULTS: There were a total of 50 women who underwent surgery for breast cancer following NACT. The mean age was 56.5 years. The majority (59.1%) belonged to stage IIIB followed by Stage III A ( 30.6%). 73.4% of cases showed clinical partial response, 14.2 % showed no response and 12.2 percent showed Pathological Complete Response (pCR). ER and PR negative and Her 2 positive status were the parameters significantly associated with pCR. CONCLUSIONS: Pathological evaluation is the most reliable method to assess response to NACT in breast cancer patients which may further influence management decisions. This study showed a much lower frequency of pCR when compared to other Indian studies. It is recommended that all patients who are treated with NACT undergo prior core needle biopsy with hormone receptor and Her 2 testing as they may have a bearing on pCR.