Neoadjuvant chemotherapy with Epirubicin / Cyclophosphamid high dose in locally advanced breast cancer (T2-T4/NO-N2/MO)

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Objective: The timing of chemotherapy (CHT) in relation to surgery has recently been the subject of intensive investigations. The response of the primary tumor is a reliable prognostic factor and can in addition be regarded as an “in vivo” chemosensitivity test Is it possible to achieve a higher rate of breast conserving therapy (UCT) on locally advanced breast cancer by neoadjuvant treatment? The efficiency on the primary tumor and on the lymphatic nodes will be presented.

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Method: 61 patients (pts) with breast cancer primarily not suitable for BCT were treated with 3 cycles of Epirubicin (120 mg/m) and Cyclophosphamid (600 mg/m). To prevent serious neutropenic side effects G-CTS was applied prophylactic. 2-3 weeks after the 3rd cycle surgery was performed. Pathologic evaluation of the tissue followed.

Results: After neoadjuvant chemotherapy BCT could be performed in 47pts. (76%). In 15pts. a modified radical mastectomy could not be avoided. 458% of the axillary lymphatic nodes that were clinically positive before treatment converted to pathological negative nodes after CHT. Tumor stage was: 2 times ypTO (3.2%), 3 times ypTis (4.9%), 2 times ypTI (34.6%), 22 times ypT2 (36%), 6 times ypT3 (9.8%), 5 times ypT4 (4.9%) and 2 times ypTx (3.2%). According to the clinical and histological results, the overall response rate (CR+PR) was calculated: RR=68,9%. Clinical complete remissions were found in 14.8% of all tumors, but complete pathological remission was observed in only 34%. 19 breast cancers (31,1%) showed only less than 20 percent decrease after CHT (Stable Disease, SD), but there were still some patients in this group who could be treated with BCT.

Conclusion: Downstaging of locally advanced breast cancer is possible by neoadjuvant chemotherapy, BCT was enabled in 76%. 68.9% of the tumors responded to this therapy with a reduction of the tumor size of more than 20%.