Cancer du sein traité par chimiothérapie première: facteurs prédictifs du traitement radical (étude rétrospective à propos de 72 cas)

Neoadjuvant chemotherapy has become the first-line treatment for locally advanced breast cancers. On the one hand, it allows for increasing options of breast conservation without an increased risk of recurrence, on the other hand it allows for locoregional control of patients with inoperable cancer. However, some clinical, radiological and histological factors are associated with an increased risk of mastectomy, such as microcalcifications, multifocality, SBR1 and 2 grade, cT3 and cT4 stages and overexpressed HER2. The purpose of this study was to determine the predictive factors for mastectomy after neoadjuvant chemotherapy (NAC), whether mastectomy was justified or not histologically and what were the predictors for unjustified mastectomy. We conducted a retrospective study of 72 patients with breast cancer treated by neoadjuvant chemotherapy in the Departments of Gynecology and Medical Oncology at the Fattouma Bourguiba Hospital in Monastir, Tunisia. The rate of conservative treatment was 18.1%; 63.15% for stage T2 tumors. Mastectomy was not justified by definitive histologic diagnosis in 26.3% of cases. In our study, unjustified mastectomy predictors were negative RH status and CT2 stage. This study led to reflection on our practice and its modifications. Conservative surgery should be considered as standard therapy and should be routinely suggested to all patients treated with neoadjuvant chemotherapy for breast cancer, including the cases with multifocality, large clinical tumor size, extensive microcalcifications, in order to significantly reduce the number of unjustified mastectomies.