NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVAN CED CARCINOMAS OF THE BREAST - TUMOR-REGRESSION AND PERIOPERATIVE COMPLICATIONS

Starting October 1991, 95 patients with a primary breast cancer were i ncluded in the present study performed at the Department of Obstetrics and Gynaecology of the Heidelberg University. In these 95 patients, r emission after neoadjuvant chemotherapy (NACT), number of operations p erformed, rate of breast conserving procedures, and postoperative comp lications were evaluated by matched-pairs analysis. For the Study grou p of 95 women, who underwent surgery from October 1991 to December 199 4, in which we attempted to increase the breast conserving rate by NAC T, a group of 95 patients without NACT (same histologic tumour stage, age, menopausal status) served as controls. Down staging was achieved in 80% of cases (n = 78), a histologically complete remission in 2% (n = 2). Tumour progression was seen in 9 patients (9%). Overall, 65% of the women (n = 62) in whom organ preservation would not have been pos sible without NACT, could be operated on by breast consenting surgery. The rate of secondary and tertiary modified radical mastectomies afte r NACT was 7.5 times, that of re-resections 6 times higher than in the control group (p < 0.001). Thus more surgical interventions had to be performed in the study group compared to the controls (n = 123 after NACT versus n = 100 no NACT). Postoperative hospitalisation was increa sed after NACT (12.5 days vs. 17.2 days; p = 0.002). Wound infections and seromas occurred twice more often in the study group. The results reflect the complexity of surgery after NACT. Intraoperative localisat ion and/or determination of the tumour margins is sometimes rendered d ifficult after chemotherapeutic changes in the former tumour bed. Clea r advantages of NACT are feasibility of breast concerving surgery in r esponders, and good evaluation of tumour response to chemotherapy. How ever, it appears that NACT is associated with more secondary operation s (re-resections and/or secondary modified radical mastectomies) and h igher complication rates.