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Surgical Issues and Preoperative Systemic Therapy

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Advances in Breast Cancer Management, Second Edition

Part of the book series: Cancer Treatment and Research ((CTAR,volume 141))

Neoadjuvant (preoperative) chemotherapy was initially developed as a treatment strategy for patients presenting with locally advanced breast cancer, as a means of improving resectability and locoregional control. This treatment sequence has now become standard, conventional practice for patients with bulky cancers of the breast and axillae. Two important advantages identified from this experience have resulted in extension of the neoadjuvant therapy approach to include early-stage breast cancer patients as potential candidates: (i) primary disease downstaging, thereby increasing lumpectomy eligibility (ii) earlier assessment of chemosensitivity versus identification of patients with resistant disease, thereby providing opportunities to individualize therapy

Furthermore, several studies have documented the finding that response in the breast correlates with survival, thereby demonstrating that primary tumor downstaging is an excellent surrogate marker for systemic therapy effectiveness. Many breast cancer patients will benefit from systemic therapy to control occult micrometastases in distant organs. As insights broaden regarding the heterogeneity of tumor biology, and as we learn more about treatment toxicity, it has become abundantly clear that expansion of the systemic therapy armamentarium is warranted. Assessment of novel therapies in the prospective adjuvant randomized clinical trial setting typically requires several thousand patient-years of follow-up, and these studies are extremely costly. Ability to evaluate new regimens in the neoadjuvant setting offers the promise of determining chemoeffectiveness within a few months, by using pathologic extent of tumor response from surgery as a surrogate for results achieved in distant organs.

Neoadjuvant chemotherapy has therefore become an advantageous treatment sequence for many reasons, and may be considered for application in any breast cancer case where the multidisciplinary oncology team is confident that chemotherapy is a necessary component of the patient’s comprehensive therapy. The decision to proceed with neoadjuvant chemotherapy is accompanied by several special considerations that must be handled by the surgeon, and these considerations involve the pre-treatment/diagnostic phase as well as local and regional management.

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  1. Breast Care Center, University of Michigan Comprehensive Cancer Center, 1500 E. Medical Center Drive, 48109-0932, Ann Arbor, MI, USA

    Lisa A. Newman M.D., Ph.D, F.A.C.P.

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  1. Northwestern University School of Medicine, 675 North St, 60611, Chicago, IL, USA

    William J. Gradishar M.D.

  2. Emory University School of Medicine, 201 Dowman Drive, 30322, Atlanta, GA, USA

    William C. Wood M.D.

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Newman, L.A. (2008). Surgical Issues and Preoperative Systemic Therapy. In: Gradishar, W.J., Wood, W.C. (eds) Advances in Breast Cancer Management, Second Edition. Cancer Treatment and Research, vol 141. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-73161-2_6

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