1. Neoadjuvant Chemotherapy in Breast Cancer Rao V, Hussein R, Manimaran N, Hurlow RA Breast Unit, Royal Shrewsbury Hospital AIM: To evaluate the benefit of neoadjuvant chemotherapy in down staging advanced cancers with view to further treatment by breast conserving surgery. Table 1. Size of the tumour (clinical) METHOD: We included all patients who were given preoperative neoadjuvant chemotherapy prior to their breast cancer surgery between 2000 and 2005 (five years). All patients were assessed by triple assessment at their initial clinic visit and decision regarding their neo adjuvant chemotherapy was made in the multi disciplinary breast meeting. RESULTS: Twenty-two patients were given pre operative neoadjuvant chemotherapy after diagnosis of advanced breast cancer. Half of them were pre menopausal and fourteen, over the age of fifty. One patient had large axillary mass and eight had inflammatory cancers. Eight patients had Nottingham Prognostic Index (NPI) of more than 5.4. The tumour sizes are shown in Table1. Eight patients had more than 50% clinical response and eight had no response to neoadjuvant therapy. Eighteen underwent mastectomy and four, lumpectomy but with level III axillary clearance. Although there was no downgrading of tumour grade, in two patients the postoperative histology did not reveal residual disease. Among T 3 cancers 40 % reduction in size was shown in mammogram and specimen histology. (Fig 1,2) All eight who were oestrogen receptor positive were treated with tamoxifen and all had adjuvant postop radiotherapy. The recurrence is as shown in Fig 3. Fig 3. Recurrence and deaths We achieved a complete clinical response in 32%( 22% in literatures), Partial clinical response in 18% ( 33%), Local recurrence rate in 18 % of cases ( 3 - 27% ). Breast conservation was achieved in 18 % of cases ( 22- 89% in literatures. DISCUSSION: Neoadjuvant therapy implies chemotherapy or hormonal therapy initially before surgical intervention. Invasive cancer must be positively identified using core biopsy and the receptor, HER 2 status of the cancer must be determined. It is imperative to clearly document the site of the tumour and mark them at the time of core biopsy to ensure localisation of the tumour at operation, should the patient have a complete clinical response. Most common adjuvant chemotherapy protocols include anthracycline and cyclophosphomide. CONCLUSIONS: Estimating completeness of response after neoadjuvant chemotherapy is difficult. Mammogram is not accurate. MRI Scan is better and newer PET Scan may be best. Fig 1. Tumour size Pre (red) and post (black) neoadjuvant therapy Fig 2. Comparison of pre op mammograhic (red) and post op histology measurements. ASSOCIATION OF SURGEONS IN TRAINING, EDINBURGH, 2006 REFERENCES: 1.Neoadjuvant chemotherapy in breast cancer: H. Charfare, S Limongelli,A D Purushottam:BJS 2005;92:14-23 2. A reduction in the requirements For mastectomy in a randomized Trial of neoadjuvant chemo endocrine therapy in primary breast cancer: A Makris, T J Powles, S E Ashley, J Chang, T Hickish, V A Tidy, A G Nash & H T Ford: Annals of Oncology 9:1179-1184,1998. 1 patient None Not Known 7 patients None No tumour 7 patients 18 patients T 3 (>5cm) 6 patients 3 patients T 2 (2-5 cm) less 1 patient Axillary mass Post chemo Pre chemo