title: Neoadjuvant chemotherapy in locally advanced breast cancer.
abstract: OBJECTIVE
  To assess the response to Neoadjuvant Chemotherapy (NAC) in Locally Advanced Breast Cancer (LABC) in terms of pathological response, overall survival and feasibility of breast conservation surgery.
  
  
  METHODS
  Case series.
  
  
  METHODS
  King Fahad Medical City (KFMC), Riyadh, from January 2009 to July 2012.
  
  
  METHODS
  All patients of LABC who received NAC and underwent surgery were included. All these patients received the GORG001 regimen (FEC+Docetaxal+Cisplatin+/-Herceptin). After chemotherapy patients were offered surgery either Modified Radical Mastectomy (MRM) or Breast Conservation Surgery (BCS) +Radiotherapy. Patients were then followed to exclude local or distant metastasis. RESULTS were described in percentage.
  
  
  RESULTS
  The median age at the time of diagnosis was 46.8 years. While complete response was achieved in 24 (44.4%) patients, 14 (25.9%) of the patients had partial response and 16 (29.6%) progressed clinically. Surgery was performed in these patients after NAC. Forty (74%) patients had MRM, 14 (25.9%) had BCS; all had axillary lymph node dissection. Invasive ductal carcinoma accounted for 92% of cases. Vascular invasion was present in 12 (22%) of the patients. Estrogen / progesterone receptor positivity was 61%. Thirty nine percent of the patients were Her2 positive. On an average, follow-up of 4 - 51 months in the MRM group, one patient had resection margin (deep) positive and was treated with adjuvant therapy. While in the BCS group after 3 - 26 months of follow-up, one patient had resection margin positive (medial margin) and underwent MRM, while no patient had local or distant metastasis in both the groups.
  
  
  CONCLUSIONS
  NAC caused down staging of disease in LABC making more conservative surgery feasible. BCC should be considered as an option for treatment of LABC, however, longer follow-up is recommended.
authors.affiliation: Department of General Surgery, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.
authors.forename: Javeria
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: Department of General Surgery, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.
authors.forename: Alam Ara
authors.initials: AA
authors.lastname: Shafi
authors.affiliation: Department of General Surgery, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.
authors.forename: Bandar N
authors.initials: BN
authors.lastname: Alharthi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000628:therapy; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D018719:Erb-b2 Receptor Tyrosine Kinases