Pathological Response after Neoadjuvant Chemotherapy in Invasive Lobular Carcinoma

Saad Alqahtani, Adher Alsayed, Amal Alhefdh and Osama Al Malik

Department of Surgery, Majmaah University, Saudi Arabia
Department of Medical Oncology, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
Department of General Surgery, King Faisal Specialist Hospital & Research Centre, Saudi Arabia

^*Correspondance to: Osama Al Malik 

 PDF  Full Text DOI: 10.25107/2474-1647.1821

Abstract

Introduction: Invasive Lobular Carcinoma (ILC) represents about 5% to 15% of all invasive breast cancers and has distinct clinico-pathological features and biological behavior. Neoadjuvant Chemotherapy (NACT) improves operability and increases the rates of Breast Conservative Surgery (BCS) by down-staging the tumor. The primary aim of this study was to assess the Pathological Complete Response (PCR) rates in ILC treated with NACT. Secondary aims included comparisons between ILC and Invasive Ductal Carcinoma (IDC) with regards to clinical response rates, rate of BCS, Disease-Free Survival (DFS) and Overall Survival (OS).Methods: A retrospective case-control study included all cases with ILC treated at King Faisal Specialist Hospital & Research Centre (KFSH&RC) from 2002 to 2012 who received NACT and were compared to a control group with IDC in a 1:2 ILC/IDC ratio (ILC=31 vs. IDC =62 patients).Results: ILC were slightly older and had higher hormone receptor positivity. There was no significant difference between the two groups with regards to menopausal status, clinical stage and the type of NACT. The Complete Clinical Response (CCR) rate (p=0.1) and the PCR rate (p=0.045) was higher in IDC compared to ILC. The mastectomy rate was higher in ILC compared to IDC (90.3% vs. 75.8%, respectively, p=0.04). The median follow up for this study was 40.5 months (range: 3 to 152). There was no difference in DFS among the two groups, but a higher OS was observed in the IDC group (p=0.02).Conclusion: Similar to most reported studies, ILC is associated with lower CCR, PCR and BCS rates. ILC is associated with a worse long-term outcome despite a higher rate of estrogen-receptor positivity.

Keywords

Invasive lobular carcinoma; Invasive ductal carcinoma; Neoadjuvant chemotherapy; Pathological complete response

Cite the article

Alqahtani S, Alsayed A, Alhefdhi A, Al Malik O. Pathological Response after Neoadjuvant Chemotherapy in Invasive Lobular Carcinoma. Clin Surg. 2017; 2: 1821.