Introduction. The concept of “regional breast cancer” (RBC) includes tumors with different clinical and biological characteristics. This group includes IIIa stage, IIIb stage, IIIc stage and partially IIb stage cancer comply with the TNM classification (6th edition).
Work objective: (a) to evaluate the neoadjuvant polychemotherapy role in the complex treatment of patients with RBC, (b) to compare the treatment results depending on the scheme and regime of polychemotherapy (PCT), (c) to monitor the effectiveness of treatment that is determined by the degree of tumor pathomorphosis and indicators of the overall and disease-free survival.
Application of PCT in the neoadjuvant mode at RBC. RBC treatment (or primary inoperable RBC) includes preoperative (induction) treatment, local treatment (surgery or radiation therapy (RT), or the RT with surgery combination) and adjuvant therapy.
Preoperative chemotherapy was first used for the treatment of regional breast cancer with the goal of the process translation into an operable condition and increase the life expectancy of female patients.
Clinical and morphological forecasting factor. Fixation of tumor to chest wall, tumor ulceration, swelling and redness of the breast skin substantially burden the prognosis of the disease, which allowed C. Haagensen and A. P. Stout to attribute these symptoms to signs of inoperability. According to Blokhin Russian Cancer Research Center of RAMS, the most frequent of these symptoms is a skin edema. The presence of skin edema in patients without systemic therapy is accompanied by a 10-year disease-free survival (DFS), that is equal to 0%. The fate of these patients suggests that, with the advent of breast skin edema, the breast cancer becomes a system disease, and its treatment is impossible without systemic therapy.
Pathomorphosis in the neoadjuvant PCT application. For example, as reported by H. M. Kuerer et al., for regional breast cancer patients with complete morphological effect (CME), both in a mammary gland and in lymph nodes, the 5-year DFS made 87%, which is significantly higher than for patients with no CME, — 58% (p<0.01).
Conclusions. With regard to the above, RBC is a systemic disease, and therefore the success in its treatment is associated with the progress and individualization of the systemic therapy.
The presented literature review provides (a) an opportunity to assess the important role of systemic polychemotherapy in the complex treatment of regional breast cancer patients, (b) the difference in treatment results depending on the scheme and mode of polychemotherapy, (c) the efficacy of neoadjuvant treatment, which is determined by the degree of a tumor pathomorphosis and indicators of the overall and disease-free survival.