To Compare the Effects of Adjuvant and Neoadjuvant Chemotherapy on Outcome of Stage III Carcinoma Breast

BACKGROUND At present, the ideal treatment of patients diagnosed to have carcinoma breast includes multimodal treatment therapy. However, the sequence of various modalities in the treatment of breast cancer varies according to the stage of the tumour at the time of presentation. Early breast cancer cases first undergo surgical treatment modality before systemic therapies, while advanced cases should undergo systemic therapies first followed by surgical interventions if possible. However, treatment of stage IIIA and IIIB patients (locally advanced disease) but having an operable lump poses a dilemma of whether to go for surgery first or systemic therapy first. We wanted to compare the outcome in terms of metastasis/recurrence between adjuvant and neo-adjuvant chemotherapy in selected cases of stage IIIA and stage IIIB carcinoma breast for a follow-up period of 1 year at a tertiary care hospital in central India. METHODS This is a comparative observational study conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH) of Jawaharlal Nehru Medical College from October 2017 to Sept 2019, which included patients of TNM stage IIIA and IIIB breast carcinoma, half of whom were treated with adjuvant chemotherapy and other half treated with neoadjuvant chemotherapy along with standard surgical procedure like MRM/toilet mastectomy. RESULTS Distribution of patients according to presence of lymphovascular Invasion was done which was statistically non-significant. However, when disease recurrence or disease metastasis/mortality was compared with lymphovascular invasion in neoadjuvant group, it was found to be statistically significant (p value=0.022) In the adjuvant group 90 % of patients belonged to stage IIIA while in neo-adjuvant group only 50 % patients belonged to stage IIIA. Rest patients in both group belonged to stage IIIB. This difference in adjuvant and neo-adjuvant group was statistically significant. (p=0.022) In comparison of outcome in both adjuvant and neo-adjuvant chemotherapy, 5% patients of adjuvant group developed metastasis and died succumbing to it while another 5 % developed recurrence during follow up. In the neo-adjuvant group 35% patients developed distant metastasis or died due to disease while another 5 % patient developed local recurrence in axilla for the disease. This difference in the outcome of two groups was statistically significant with p value of 0.013. CONCLUSIONS In our study we found that for a locally advanced breast cancer patient (stage IIIA &B) with an operable breast lump, adjuvant chemotherapy is superior than neoadjuvant chemotherapy with a significant p value of 0.013. Superior in terms of lesser distant metastasis/recurrence when we followed up the patient for 1 year after the completion of treatment.