The outcome of breast conservative surgery vs modified radical mastectomy following neoadjuvant therapy among locally advanced breast cancer patients in national cancer institute, Gezira University, Sudan

Background: Locally advanced breast cancer (LABC) is still a common presentation in Sudan. Lack of awareness of guidelines lead to high rates of unnecessary mastectomies among patients with locally advanced breast cancer. 

Objective: To compare the outcome of breast conservative surgery and modified radical mastectomy after neoadjuvant therapy for locally advanced breast cancer. 

Patients and Methods: Descriptive, cross-sectional, and hospital-based study. Included all the patients with locally advanced breast cancer seen in the National Cancer Institute-University of Gezira from the period of December 2018 to February 2020 and who received neoadjuvant therapy followed by surgery. 

Results: Forty-seven patients met the inclusion criteria of the study. The mean age of patients presented with LABC is 47.3 years (+/- 11.6 years) with the majority of patients, 31 patients (66%) less than 50 years and 24 patients (51.1%) are premenopausal. The commonest AJCC stage is stage IIIB in 37 patients (78.7%), 41 patients (87.2%) of tumors are invasive ductal carcinoma and 31 patients (66%) are estrogen receptor and/or progesterone receptor positive. Fortyone patients (87.2%) received anthracycline and taxane-based chemotherapy and 97.9% achieved partial clinical response. Breast conservative surgery was done for 13 patients (27.7%) and modified radical mastectomy for 27 patients (72.3%). There is no statistical difference in the outcome of BCS compared to MRM (P value 0.661). Negative predictive factors of the outcome include skin ulceration, negative ER/PR status, and omission of adjuvant radiotherapy (p-value < 0.05 for each variable). 

Conclusion: At 15 months follow-up, there is no difference in the final outcome of BCS and MRM following neoadjuvant therapy in the LABC.