Neoadjuvant Chemotherapy with Breast Conservation for Locally Advanced Ductal and Lobular Invasive Carcinomas Combining Multimodality Strategies

Background: Breast-Conserving surgery (BCS) has generally been limited to T1 and T2 lesions because it has been thought impossible to achieve good local control with satisfactory cosmesis in patient with more advanced disease. However, many patients with T3 and T4 lesions will exhibit dramatic tumor down staging with neoadjuvant Chemotherapy. Several studies reports low rates of breast conservation after neoadjuvant chemotherapy for operable breast cancers not amenable to initial breast-conserving surgery. Aim of the Work: This study aims to compare the outcome of lobular vs ductal carcinomas after neoadjuvant chemotherapy and to report their local control after conservation breast surgery or mastectcomy. Material and Methods: Between 2005 and 2010, 77 patients with clinical stage II/IIIA (invasive ductal carcinoma (IDC) 56 and invasive lobular carcinoma (ILC) 21 breast carcinomas were treated at the Mansoura University Hospital-Department of Oncology and Nuclear Medicine and Mansoura Concology center with primary anthracycline-based poly-chemotherapy followed by either breast conservation (surgery and/or radiotherapy) or mastectomy. Median follow-up was 2/5 years. Clinical response to primary chemotherapy was significantly worse for lobular than for ductal carcinomas (46 vs 59%; p=0.04), but only histological grade remained predictive in multivariate analysis. Conclusion: After neoadjuvant chemotherapy breast conservation was high for both ductal and lobular carcinomas the lobular type had no adverse effect on locoregional control or overall survival, even in the group of patients treated with breast conservation.