A Clinical Study of Locally Advanced Carcinoma of Breast

Abstract

BACKGROUND: In India it is observed that most of the patients of breast cancer clinically present in late stage due to their ignorance of disease despite so much advancement in its detection and management. Locally advanced breast cancer (LABC) accounts for 30-35% of all cases of breast cancers in India. This study aims to evaluate Clinical features, Investigations, various Treatment modalities and the Clinico-pathological correlation & outcome of various treatment modalities of LABC, with special emphasis on Neo-adjuvant chemotherapy (NACT) in Indian setting. MATERIAL AND METHOD: This was a non-randomised prospective observational study. We analyzed 57 patients of LABC Stage IIIB & IIIC presenting at Government Medical College, Nagpur, Maharashtra, a tertiary care Centre from September 2012 to November 2014. RESULTS: Stage IIIB comprised 84.21% patients while remaining 15.79% were having Stage IIIC disease. Skin involvement was observed in 91.23% patients. 15.79% showed supraclavicular lymph node involvement. 32 patients received NACT (2 to 6 cycles). Out of these 32, complete clinical response (cCR) was 12.5%, partial response (cPR) was 68.75% and pathological CR (pCR) was 6.25% with Total Objective response (cCR+cPR) 81.25%. Feasibility of Breast Conserving Surgery (BCS) was observed in 12.5% patients. 25 patients underwent primary surgery followed by adjuvant chemotherapy. Modified Radical Mastectomy was performed in 89.48% patients. CONCLUSIONS: With overall clinical response of 81.25%, neoadjuvant chemotherapy is the best treatment option for patients with Locally Advanced Breast Cancer with added advantage of in vivo testing the sensitivity of chemotherapeutic agents, early management of micrometastasis and down staging the primary tumour with feasibility of BCS. Patients presenting LABC constitute a diverse group for which a variety of treatment modalities should be instituted with coordinated treatment planning among surgeons, medical oncologists and radiation oncologists.