P5-23-07: Treatment Strategy of Locally Advanced Breast Cancer in Sub Group (T3N1M0, T4bN1M0) in Developing Countries.
Authors: Gupta AK , Kaushal M 
Published: June 2012

With the recent advances in modern day chemotherapy and hormonal therapy for locally advanced breast cancer [stage III, T3 N1 and T4bN1], most of the oncologist around the globe now prefer to give neoadjuvent chemotherapy and, or hormonal therapy followed by surgery in the treatment of these cases.

Randomized research have also shown that this strategy provides ‘pathological complete resolution’ as compared to surgery and then adjuvant chemotherapy in terms of decreasing in size of tumar, decrease in vascularity of tumor mass and micrometastasis. Some author believes that this improve the overall survival duration of patients.

This protocol is widely accepted but ….

BUT WHAT IF YOU LOSE YOUR PATIENT ON FOLLOWUP …

Especially in the developing countries of south east asian region and African continent, where there is poor socioeconomic status and lack of education among common people. The patient gets frustrated after first few doses of neoadjuvent therapy, due to side effects of chemotherapy and don't consider chemotherapy as a treatment compare to surgery. Thus the patient loses faith in treatment strategy itself and go untraceable after one or two sessions of the therapy. The government of developing countries lack resources in terms of manpower and money for satisfactory completion of treatment making the above condition even worse. In our study we followed 230 patients of locally advanced breast cancer in subgroup of stage III [T3 N1, T4bN1] and divided them into two plans on random basis. In first plan we approached with the surgical management followed by adjuvant chemotherapy & counseled the patients for completion of chemotherapy. This plan was shown to 115 patients, out of which 100 patients provided good acceptance & completed the course of chemotherapy. There were 15 patients who remained untraceable after surgery.

On the other hand in the 2 group the patients were counseled for neoadjuvent chemotherapy and then surgery in next stage. In this group 115 patients were introduced, out of which 60 patients were lost on follow up after 2–3 sessions. The majority of patients complained about the side effects of chemotherapy and financial reasons and did not come back. Rest of the patients completed the whole course. With no doubt about the result of the treatment, the second group has equivocal survival advantages in terms of morbidity and mortality, but we lost more than half of the patients of second group before completion of treatment.

Primarily the acceptance of surgical treatment is more in developing countries, as it is quite more feasible for government and even economical for common people. Thus we prefer the strategy of surgery followed by adjuvant chemo/hormonal therapy in locally advanced breast cancer [stage III T3N1, T4bN1] especially in developing countries like India.

THE MOTTO OF THIS STRATEGY IS TO PROVIDE BENEFIT OF COMPLETE TREATMENT TO THE PATIENT THAN TO LOSE THE PATIENT COMPLETELY BEFORE TREATMENT.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-23-07.