Neoadjuvant chemotherapy is treatment that is given after diagnosis, but before surgery. This means that a woman will have had a biopsy, possible some other staging exams, but not yet a wide excision/lumpectomy or a mastectomy. This sequence is sometimes suggested when the tumor seems aggressive (so the wish is to start systemic treatment ASAP) or is quite large (and the hope is to shrink it enough so that a lumpectomy, rather than a mastectomy, will be feasible). This editorial from the Journal of Clinical Oncology discusses the value of this treatment plan. Here is the beginning and then a link to read more:
Defining the Benefits of Neoadjuvant Chemotherapyfor Breast Cancer
Anne F. Schott and Daniel F. Hayes, University of Michigan, Ann Arbor, MI
Preoperative or neoadjuvant chemotherapy is an option in patients with early-stage breast cancer. Neoadjuvant treatment has been compared with standard, postoperative adjuvant chemotherapy with the dual goals of improving survival and facilitating local therapies. Unfortunately, neoadjuvant chemotherapy does not seem to improve overall survival, as demonstrated in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B18 trial, among others.
Neoadjuvant chemotherapy may convert a previously unresectable, locally
advanced breast cancer to an operable tumor, and in primarily operable tumors, downstaging results in a small increase (7% to 12%) in breast conservation rates. However, many patients experience insufficient response or are not candidates for breast preservation, irrespective of response, because of either skin or chest wall involvement or multicentric or multifocal disease.
Furthermore, an estimated 10% of American women choose mastectomy as a personal preference despite their surgeons' recommendation of breast-conserving therapy.
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