The impact of neoadjuvant chemotherapy on

Breast cancer
Thesis
Submitted for partial fulfillment of Master Degree
in Clinical Oncology and Nuclear Medicine

Investigator
Doaa Mahmoud Ahmed Abdelwahab
Resident of Clinical Oncology and Nuclear Medicine
Faculty of Medicine, Mansoura University

Supervisor
Prof.Dr. Nawal Mohamed Elsayed ELkholy
Professor of clinical oncology and nuclear medicine
Faculty of Medicine, Mansoura University

2022
 Introduction
Breast cancer is considered the most common cancer among
women worldwide to a degree that the death related to it reached
620,000 in 2018 alone according to the World Health Organization
(World Health Organization, 2020).
In Egypt, breast cancer is also the most common cancer in females
; with 28,000 confirmed cases / year as reported by the National Cancer
Institute (NCI), Egypt (National Cancer Institute, 2020).
The Egyptian Breast Health Presidential Initiative didn’t aim only
to detect and diagnose breast cancer in early stage but also to set up a
basic level of awareness on the risk factors of the disease (The
President’s, 2020).
Many of the established breast cancer risk factors are related to
early menarche, late menopause, obesity, late age of first pregnancy,
fewer pregnancies, shorter or no periods of breastfeeding, alcohol
consumption, physical inactivity, family history and hormone
replacement therapy (HRT) (Carbine et al., 2018).
There are different modalities for treatment of breast cancer
including surgery, chemotherapy, radiotherapy , endocrine (hormone)
therapy (ET) and targeted therapies .The standard treatment option varies
depending on type and stage of the cancer (Dhankhar et al., 2010).
Chemotherapy can be used in breast cancer as neoadjuvant,
adjuvant and palliative treatment.The neoadjuvant chemotherapy
significantly used in locally advanced breast cancer; as it facilitates breast
conservation, can render inoperable tumors operable, allows time for
genetic testing. It also allows time to plan breast reconstruction in
patients electing mastectomy ,as well as the response to the neoadjuvant

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treatment can provide important prognostic information at an individual
patient level (NCCN Guidline version-2, 2020)..
Neoadjuvant chemotherapy is effective as adjuvant chemotherapy
regarding survival for locally advanced breast cancer (Deo et al., 2003).
Other types of Neoadjuvant treatments can be used in breast
cancer are: neoadjuvant Endocrinal therapy and neoadjuvant targeted
therapy . Endocrine therapy , is only effective for oestrogen receptor
(ER) positive disease, while chemotherapy achieved Higher pathological
complete response( pCR) rates up to 4 folds in ER-negative disease
compared with ER positive cancers (Zambetti et al., 2012). High grade
tumour differentiation and young age patients have increased the benefit
from neoadjuvant chemotherapy in ER negative cases (Huober et al.,
2010).
However , chemotherapy and hormonal therapies have similar
response rate in case of postmenopausal women with ER +ve cancer
(Semiglazov et al., 2007). Target therapy as trastuzumab is added to
anthracycline- taxane- based chemotherapy in HER2 positive (human
epidermal growth factor receptor 2) disease to give higher pCR than
treatment with chemotherapy alone (Gunter von Minckwitz et al., 2012).

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 The aim of the work
Our study aims to:
1 - To evaluate the impact of neoadjuvant chemotherapy on breast cancer
as regard response rate and down-staging.
2-To evaluate the impact of neoadjuvant chemotherapy on breast cancer
as regard Disease free survival (DFS) , overall survival (OS)

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Inclusion criteria:
1- Locally advanced breast cancer.
2- Early breast cancer with high risk factors.
Exclusion criteria:
1- Double malignancy
2- Age < 18 year old
3- Stage T1N0
Patients and methods:
This is a retrospective study of patients with invasive breast
cancer, received neoadjuvant chemotherapy and attend at Clinical
Oncology and Nuclear Medicine Department ,Mansoura University
Hospital ,health insurance oncology center between first of January 2018
to December 2021, with a sample size about 50 patients .
The data collected from the patients files (complain, physical
examination, laboratory work up, radiological assessment, pathological
diagnosis and treatment. Disease free survival (DFS), overall survival
(OS) will be analysed.

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Ethical considerations:
Study protocol will be submitted for approval by Medical Research
Ethics Committee.
Faculty of medicine, Mansoura University
Statistical analysis:

Data will be tabulated together with subset analysis according to

baseline characteristics . The statistical analysis will be done using
SPSS. Kaplan Meier method will be applied for survival analysis.

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