BREAST SURGERY AFTER NEOADJUVANT TREATMENT - IS IT NECESSARY

The optimum management of women with advanced loco-regional breast can cer (T-3-4, N-1-2) is controversial, Neoadjuvant therapy in the form o f chemotherapy and or radiotherapy is popular and results in an encour aging local response in over 70% of patients, However, should subseque nt surgery (either mastectomy or breast conservation treatment) be und ertaken in women who respond? We present a prospective evaluation of 1 5 patients with T-3-4, N-1-2 tumours (including 1 bilateral cancer), w ho underwent mastectomy after achieving a complete clinical response t o neoadjuvant treatment, All patients had 6 cycles of chemotherapy and 10 also received 50 Gy radiotherapy, In addition to clinical examinat ion, the response to neoadjuvant treatment was assessed by mammography (in all cases) and by magnetic resonance imaging (MR) (in eight patie nts), Careful histopathological assessment of the breast was undertake n to determine the extent of residual disease, In all patients histolo gical malignancy was recognized within the breast, The size varied fro m 0.6 to 6.5 cm in maximum diameter with three grade I, eight grade II and five grade IlI tumours, Axillary lymph nodes were positive in sev en patients, In conclusion, surgery is indicated for control of residu al disease in locally advanced breast cancer regardless of the respons e to neoadjuvant treatment, Our preliminary observations suggest a pot ential role for breast MR in defining the extent of residual disease w hich map aid in the planning of surgery.