Neoadjuvant radiotherapy in locally advanced breast cancer refractory to chemotherapy – a single institution experience in Brazil

Aim/Background

Locally advanced breast cancer (LABC) is a major health problem in Brazil. Nearly one third of LABC are resistant to multimodal neoadjuvant treatment remaining unresectable. As alternative to downsize tumor and allow surgical removal, neoadjuvant radiotherapy has been reported as an option. The aim of this study was to evaluate the tumor resection feasibility after neoadjuvant radiotherapy in LABC unresectable despite standard neoadjuvant multimodal therapy has being done. We also analyzed patients and tumors characteristics as well the outcomes.

Methods

Retrospective cohort study, which evaluated 55 patients with LABC who were treated with at least one chemotherapeutic regimen and were not eligible to tumor surgical removal, being submitted to neoadjuvant radiotherapy until December 2012.

Results

The median age was 49.9 years. Tumor staging at diagnosis was: EIIA 1,8%, IIB 5,4%, IIIA 20%, IIIB 71% and IIIC 1,8%. The median tumor size at diagnosis was 9.17 cm (4-17cm) and median clinical lymph nodes affected was 1.1 (0-4). The differentiation grade was: G1 1,8%, G2 23% and G3 29%. All patients were submitted to radiotherapy with 50Gy in 25 fractions involving the breast and nodal drainage chains. The medium time to surgery after radiotherapy was 20 weeks. Forty two (76%) of patients were downsized by radiotherapy and performed surgery. Surgical complications were infrequent with 6 (14%) patients presenting wound infection and 9 (21%) suture dehiscence. The medium time to recurrence was 30 months with overall survival at two and five years of 67% and 36%, respectively. Ten patients are being followed without recurrence. The most frequent sites of systemic recurrence were: lungs 23,6%, bone 18%, liver 16% and brain 5,4%. Local recurrence were less frequent: lymph nodes 18% and skin 5,4%.

Patients and tumor characteristics

Conclusions

Neoadjuvant radiotherapy is an effective treatment to downsize breast cancer tumors with low or absent response to chemotherapy and enable surgical resection.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.