RECIST criteria and doppler score in the evaluation of neoadjuvant chemotherapy in locally advanced breast carcinoma

Abstract

Introduction

Breast cancer is the commonest cancer in women. It accounts for 25-31% of all cancers in the female population of India, 30-35 % of which present at locally advanced stage. This study was undertaken to evaluate the effect of neoadjuvant chemotherapy on locally advanced breast cancer (LABC).

Material and Methods

Thirty-four patients with LABC admitted to Ram Manohar Lohia Hospital, New Delhi were analysed. All patients were diagnosed on FNAC, mammography and pre-treatment Tru-cut biopsy for detailed histological pathological diagnosis and tumour markers. Colour doppler ultrasonography was performed in all cases for vascularity which included peak flow velocity (Vmax), resistivity index (RI) and pulsitile index (PI). Patients were given three cycles of neoadjuvant chemotherapy (NACT) at three-weekly intervals that consisted of cyclophosphamide adriamycin and 5-fluorouracil. Their response to NACT was evaluated after the third cycle; the patients were assessed for clinical response in terms of reduction in tumour size and by colour doppler study to record the changes in tumour vascularity.

Results

All patients reported a 2-month to 2-year history of a lump in the breast. The age of the patients ranged from 25 to 75 years with a mean age of 48.85 years. T3 and T4 tumours were equally distributed and eleven patients had clinically palpable axillary lymph nodes. Twenty, 10 and 12 patients tested positive for ER, PR and HER2/neu respectively.

Post NACT, 26 patients showed partial response, but none displayed complete response. Colour doppler ultrasonography showed a decrease in RI, PI and Vmax values.

Conclusion

Partial response to NACT was achieved in 76.5% of cases according to RECIST, and the doppler score for tumour vascularity decreased.