Role of Neoadjuvant Chemotherapy with Cyclophosphamide, Adriamycin, 5-Fluorouracil (Caf Regimen) in Down Staging in Breast Cancer.

ABSTRACT

Background: The aim of the study is to assess the tumor response to neoadjuvant chemotherapy with cyclophosphamide, adriamycin, 5-fluorouracial (CAF regimen) in terms of decrease in breast tumor size (partial or complete clinically).To assess clinically the axillary lymph node status after neoadjuvant chemotherapy (conversion from palpable to nonpalpable). Methods: Thirty female patients of breast cancer were studied for down staging with two cycles of CAF regimen given at interval of 21 days. After 21 days of second cycle patient’s staging noted for effects. Results: Thirty female patients of breast cancer were studied. Maximum no. of patients between 31-40 years, mean age 46 years and median age 45 years, youngest patients 18 years, oldest patients 70 years, 22 patients responded to chemotherapy, out of 22, 1 (3.3%) showed a complete clinical response, 21 (70%) partial clinical response. Pre-menopausal 9/13 (69.2%) and post menopausal 13/17 (76.4%) showed clinical response, statistically not significant difference (df=1, x2=1.33, p>0.05). Change in tumor size 40.09±25.20 sq, cm mean size to 21.88±27.43 sq. cm after chemotherapy was highly significant change (t=6.242, p<0.001). Overall response to chemotherapy was 73.3%, in stage II-87.5%, stage IIIA-75% and stage IIIB-50%. The overall response to axillary lymph node was 56.6%, statistically highly significant (p<0.001). Main side effects nausea and vomiting (60%) and hair loss, 43.3%, but none necessitated stoppage of chemotherapy. As a consequence to primary chemotherapy, conservation surgery (lumpectomy with axillary clearance) could be done in 43.3% of patients.Conclusion: CAF Preoperative chemotherapy regime is a satisfactory modality of treatment for stage II and III breast cancer with positive response rate of 73.3%. The down staging thus obtained permits breast conservation surgery in 43.3% of patients. The chemotherapy regime is well accepted by patients.