Clinical and pathologic response following taxane based neoadjuvant chemotherapy in locally advanced breast cancer patients in a tertiary care centre in India.

BACKGROUND: Neoadjuvant chemotherapy has become the standard recommendation in the management of patients with locally advanced breast cancer. At present anthracycline based regimen such as CAF (cyclophosphamide, adriamycin and 5-FU) is widely used in clinical practice. The introduction of taxanes has revolutionized this field because of superior results. AIMS AND OBJECTIVES: This study is designed to compare the efficacy of paclitaxel plus doxorubicin regimen and CAF (cyclophosphamide, doxorubicin and 5-fluorouracil) regimen as neoadjuvant treatment of locally advanced breast cancer and to compare their toxicity profiles and also to correlate the hormonal receptor status in predicting response to the NACT. MATERIALS AND METHODS: In this prospective study, 101 patients with newly diagnosed locally advanced breast cancer were randomized to receive either CAF or Paclitaxel/adriamycin as NACT for three cycles. The response was assessed objectively using CT scans and applying RECIST criteria. The patients were monitored for hematologic, cardiac and other minor toxicities. RESULTS: There was a significantly increased complete and objective response seen in the AP group when compared to CAF group (24% and 58% in the AP group versus 7.8% and 39.2% in the CAF group, P value 0.0313 for complete response). The pCR rate was also significantly higher in the AP group compared to CAF group. (20.93% versus 4.34%, P value 0.0237). There was no significant difference between the groups with respect to cardiotoxicity and hematotoxicity. Patients with ER negative tumors have responded well to neoadjuvant chemotherapy better than ER positive patients. (Objective response 62.8% vs. 40%, P - 0.0473). CONCLUSIONS: Based on these results, taxane based regimen such as Paclitaxel/adriamycin can be recommended as a first line neoadjuvant regimen in patients with locally advanced breast cancer.

Risk factors of female breast carcinoma: A case control study at Puducherry.

Objective: To identify and quantify various demographic, reproductive, socio-economic and dietary risk factors among women with breast cancer. Study Design: Case control study. Study Period: February 2004 to May 2005. Study Setting: Departments of Surgery, Medicine and Radiotherapy of Jawaharlal Institute of Postgraduate Medical Sciences and Research (JIPMER), Pondicherry. Materials and Methods: Cases were women with pathologically confirmed breast cancer. Controls were age-matched women from medicine and surgery wards without any current breast problem or previous breast cancer. A total of 152 cases and 152 controls were enrolled. They were interviewed for parity, breast feeding, past history of benign breast lesion, family history and dietary history with a pre-tested interview schedule after obtaining informed written consent. Results: The significant risk factors were (odds ratios with 95% CI) previous history of biopsy for benign breast lesion 10.4 (1.3-86.3), nulliparity 2.4 (1.14-5.08), consumption of fats more than 30 g/day 2.4 (1.14-5.45) and consumption of oils containing more of saturated fat 2.0 (1.03-4.52). Conclusions: Nulliparity, past history of benign breast lesion, high fat diet and consumption of oils with more saturated fats were the risk factors.

Role of template guided interstitial implants in breast conservation therapy.

Breast conservation therapy is currently considered as a viable alternative to mastectomy in early breast cancer. Radiotherapy by virtue of its ability to reduce local recurrences is an integral component of breast conservation therapy. Apart from irradiating the whole breast, the tumor bed is usually delivered a boost dose in breast conservation therapy to increase the local control rate. One of the methods which has been adopted to selectively boost the tumor bed to high doses is the use of per-operative high dose rate interstitial implants. This particular paper deals with our department's experience with breast conservation therapy using per-operative template guided, High Dose Rate (HDR) interstitial implants in early breast cancer. Local control rates, disease free survival and cosmetic benefit with this technique will be discussed along with literature review.