Pathological complete response in locally advanced breast cancer: Determinants and predictive significance.
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Date
2012-05
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Abstract
Background. Neoadjuvant chemotherapy is now the
standard approach for most large breast cancers including
locally advanced cancers of the breast. The majority of patients
respond satisfactorily to chemotherapy with effective downsizing
of tumours to consider breast conservation surgery. Pathological
complete response (pathCR) is known to be a strong predictor
of good outcome; however, many factors are known to
influence the extent of response to chemotherapy. It has been
observed that smaller the tumour, better is the response
achieved in contrast to larger and locally advanced tumours
where only one-third may respond well enough to merit breast
conservation. Various other clinical, biological and molecular
factors are also being evaluated as effective predictors of
chemosensitivity. Most of these are either not easily available
for all patients in developing countries or are overtly expensive
and not applicable for all patients.
Methods. We evaluated the clinical and pathological
predictors of response to chemotherapy in 1402 women with
locally advanced breast cancer.
Results. There was a higher rate of pathCR in smaller
tumours, younger women and ER-negative as well as triple
negative tumours. The presence of ductal carcinoma in situ
(DCIS) and lymphatic and vascular invasion (LVI) were associated
with lower pathCR.
Conclusion. In the absence of ready availability of expensive
molecular and genomic assays, clinical parameters and standard
histopathological variables can also be useful indicators of
response to neoadjuvant chemotherapy. Additionally, they
can help identify those who could be eventually conserved or
have a better outcome.
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PARMAR V, HAWALDAR R, NAIR N S, SHET T, DESAI S, BADWE R A. Pathological complete response in locally advanced breast cancer: Determinants and predictive significance. National Medical Journal of India. 2012 May-Jun; 25(3): 132-136.