Abstract:Objective：To investigate the role of neoadjuvant chemotherapy（NAC）and breast-conserving surgery for stage II,III breast cancer.
Methods：Forty-six patients with stage II,III breast cancer underwent breast-conserving surgery after neoadjuvant chemotherapy were reviewed and followed-up. The control group included 59 patients who underwent radical mastectomy only. Neoadjuvant chemotherapy protocol was as follows: intravenous injection with epirubicin 60 mg/m on day 1 and paclitaxel 150mg/m continuous intravenous infusion for 3 hours on day 2. One course of neoadjuvant chemotherapy was 21 days. Patients eligible for breast-conserving therapy in study group were given quadrantectomy or wide local excision of tumor with axillary lymph node dissection. The breast cosmetic status, local recurrence and metastasis rate were followed up after surgery.
Results：In study group, after neoadjuvant chemotherapy, 9 cases achieved clinical complete response (CR) and 37 cases achieved partial response (PR). The post-operative pathological examination showed varying degrees of apomorphosis and necrosis of tumor cell, intercellular substance edema, fibrous hyperplasia and inflammatory cell invasion. Four cases had pathological complete response. Assessment of cosmetic results, 1 year after combined therapy(chemotherapy plus radiotherapy), was carried out in 31 cases who had received breast-conserving therapy, and excellent results were obtained in 19.4% (6/31), good in 58.1% (18/31), and poor in 22.6% (7/31) of the patients. The local recurrence rate was 8.7% (4/46) in study group, and 6.8%(4/59) in control group,there was no significant difference between the two groups(P＞0.05). The metastasis rate in study group was 6.5%（3/46） and in control group was 15.3%（9/59）(P＞0.05).
Conclusions：Neoadjuvant chemotherapy followed by breast-conserving surgery for stage II and III breast cancer is safe and can achieve the results of radical operation. Neoadjuvant chemotherapy, strict adherence to standerdize surgical technique and use of postoperative radiotherapy and chemotherapy are crucial to breast-conserving therapy for these patients.