Response to Neoadjuvant Therapy
Description
This data item records the physician’s statement of response to neoadjuvant chemotherapy.
Neoadjuvant therapy is defined as systemic, or radiation treatment administered prior to surgery in an attempt to shrink the tumor or destroy regional metastases. This data item documents whether that neoadjuvant therapy was successful.
This data item is coded based on the clinician’s statement regarding response to neoadjuvant therapy. Do not try to interpret or infer a response based on the medical record. As a guide for the clinician, the definitions below are from the AJCC Cancer Staging Manual, 8th edition.
The registrar should not use these definitions to code this field
* Complete Response (CR) – absence of invasive carcinoma in breast and lymph nodes; must be determined by microscopic evaluation of tissues; residual in situ cancer at primary site
* Partial Response (PR) – a decrease in T and/or N category compared to pretreatment value and no increase, using same method of evaluation as baseline value, residual tumor in lymph nodes of any size
* No Response (NR) – no apparent change in the T or N category compared to pretreatment value, or an increase in T or N value at time of y pathological examination
Rationale
Response to Neoadjuvant Therapy is a Registry Data Collection Variable in AJCC. It was previously collected as Breast, CS SSF #21.
Additional Info
**Source documents:** physician statement
**Other names include** treatment effect
For further information, refer to the **Breast or Breast Biomarker Reporting** cancer protocols published by the College of American Pathologists for the AJCC Staging System *Breast*.
Notes
**Note 1:** **Physician Statement**
* A statement from the managing physician for Response to Neoadjuvant Therapy **must be used to code this data item**.
**Note 2:** **Response to Neoadjuvant Therapy**
* This data item evaluates the response of neoadjuvant therapy. It includes all clinical and pathological information on the primary tumor, regional nodes and distant metastasis.
* This is different than
* 1633: Neoadjuvant Therapy-Clinical Response, which evaluates clinically the effect of the neoadjuvant therapy on the tumor AND
* 1634: Neoadjuvant Therapy-Treatment Effect, which evaluates ONLY the effect of the neoadjuvant therapy on the primary tumor AFTER surgical resection (pathological evaluation).
**Note 3:** **Criteria for coding**
* A surgical resection **must be done** after the completion of Neoadjuvant therapy
* If patient does not have neoadjuvant therapy, or surgical resection, code 7
* This data item should only be coded based on the **managing physician's overall interpretation** (clinical and pathological) of the results **AFTER neoadjuvant therapy and the surgical resection are done**
* The registrar **cannot** code this data item based on pathological, radiological, and imaging findings. Only the physician can determine the response.
**Note 4:** **Related Data Items**
* The Breast Schema has several different data SSDIs related to neoadjuvant therapy. Make sure that your coding agrees across all of them
* Residual Cancer Burden (RCB) [NAACCR #1178]
* RCB Class [NAACCR #1179]
* Response to Neoadjuvant Therapy [NAACCR #3922]
Coding Guidelines
1. **Code 0: Complete response**
* Managing physician states "total" or "complete" response
* Includes a Residual Cancer Burden (RCB) result of '0' or an RCB Class of pCR (pathological complete response).
2. **Code 1: Partial Response**
* Managing physician states "partial" response
3. **Code 2: Response, unspecified**
* Managing physician states "response," but does not specify if it's partial or complete
4. **Code 3: No response**
* Managing physician states "no response"
5. **Code 4: Response, but not preferred terminology**
* When a response is noted to be present but cannot be classified to codes 0-3
* ***Examples:*** Significant response, good response, fair response, excellent response, etc.
6. **Code 5: Response not documented**
* Surgical resection is performed, but response is not documented in the **post-neoadjuvant surgical pathology report.**
7. **Code 6: Planned surgical resection is cancelled/not done**
* Patient had complete response to neoadjuvant therapy, and the surgical resection was cancelled
* Patient had neoadjuvant therapy, didn't complete it and then refused surgical resection
* ***Excludes***: Unknown if surgical resection done (see code 9)
8. **Code 7: No neoadjuvant therapy**
* ***Excludes***: surgical resection cancelled (code 6) or unknown if planned surgical resection was performed (code 9)
* Non-invasive neoplasm (behaviors /0, /1, /2)
* Autopsy only
9. **Code 9: Unknown**
* Unknown if neoadjuvant therapy administered
* Unknown if planned surgical resection performed after neoadjuvant therapy
* ***Excludes***: surgical resection done, treatment effect unknown (code 5), surgical resection cancelled (code 6)
Default
8
Metadata
SSDI
| Code |
Description |
| 0 |
Stated as complete response (CR) (per managing/treating physician) |
| 1 |
Stated as partial response (PR) (per managing/treating physician) |
| 2 |
Stated as response to treatment, but not noted if complete or partial (per managing/treating physician) |
| 3 |
Stated as no response (NR) (per managing/treating physician) |
| 4 |
Response, NOS |
| 5 |
Neoadjuvant therapy administered and surgical resection performed, response not documented or unknown
* Results cannot be determined |
| 6 |
Neoadjuvant therapy administered and planned surgical resection not performed |
| 7 |
No neoadjuvant therapy
Non-invasive neoplasm (behaviors /0, /1, /2)
Autopsy only |
| 8 |
Not applicable: Information not collected for this case
(If this item is required by your standard setter, use of code 8 will result in an edit error.) |
| 9 |
Unknown if neoadjuvant therapy administered
Unknown if planned surgical resection performed after neoadjuvant therapy |
