The role of neoadjuvant chemotherapy in the surgical management of women with breast cancer in a middle-income country

Neoadjuvant chemotherapy (NAC) in women with large breast tumours can downsize tumours to allow for breast conservation surgery (BCS). The aim of this study is to compare the BCS rate between those who had NAC versus those who underwent surgery first and to determine the factors affecting response rate. 1,183 patients, who had surgery for breast cancer in a single institution from December 2012 to December 2015, were included in this study. 80 (6.8%) patients had NAC. Patient and tumours characteristics, and type of surgery were compared between those who had surgery first or surgery after NAC. Variables affecting the response rate were analyzed. The BCS rate between the surgery first and the NAC group were similar (34.2% versus 35%). The pathological complete response (PCR) rate, partial response rate and stable disease rate was 22.5%, 65% and 12.5%, respectively. PCR rate was not significantly affected by subtype of breast cancer, although there was a tendency for PCR to be higher in ER-negative (32.4%), PR-negative (26.1%) HER2-positive (28.6%), HER2 overexpressing (37.5%) and TNBC (22.7%) tumours. NAC is able to downsize tumour to achieve BCS rate that is similar to those without NAC.