The Impact of Neoadjuvant Chemotherapy on Local-Regional Treatment of Breast Cancer
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- Mamounas, E.P. Curr Breast Cancer Rep (2013) 5: 106. doi:10.1007/s12609-013-0106-z
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Neoadjuvant chemotherapy (NC) is the standard of care for patients with locally advanced breast cancer and a reasonable alternative to adjuvant chemotherapy for those with large operable disease. Potential clinical advantages with neoadjuvant chemotherapy include the conversion of some patients requiring mastectomy to candidates for breast conserving surgery, the potential for down-staging axillary nodes, and thus, reducing the extent of axillary surgery and the ability to correlate clinical and pathologic response to neoadjuvant chemotherapy with improved long-term outcomes. Several unique local-regional therapy issues have emerged in patients who are candidates for NC. These relate to the appropriate surgical management of primary breast tumors and axillary lymph nodes as well as the optimal use of radiotherapy in this setting. Additional important issues include the accurate assessment of the location and extent of the primary breast tumor and axillary nodes before, during and after NC since this affects the execution and outcomes of local-regional therapy. In the years to come, the development of more active neoadjuvant chemotherapy regimens and novel molecular and imaging techniques, will undoubtedly lead to further individualization of breast cancer local-regional management.