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Integration of Neoadjuvant Systemic Therapy into Surgical Practice

  • Henry M. Kuerer
Chapter

Abstract

In breast cancer, the use of postoperative, or adjuvant, chemotherapy is inextricably linked to the improved outcomes seen over the past several decades. Neoadjuvant chemotherapy has become the standard of care for patients with locally advanced breast cancer and has rapidly come to the forefront among potential treatments for patients with earlier-stage operable disease. Several studies have shown that breast cancer patients treated with neoadjuvant chemotherapy do not necessarily survive longer than those treated with conventional postoperative adjuvant chemotherapy; however, the use of neoadjuvant chemotherapy has several proven and theoretical advantages. This chapter reviews the potential merits of neoadjuvant therapy as it applies to breast cancer care in general, and breast surgery in particular.

Keywords

Breast Cancer Advanced Breast Cancer Axillary Dissection Breast Conservation Therapy Ipsilateral Breast Tumor Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Powles TJ, Hickish TF, Makris A, et al. Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol. 1995;13:547–52.PubMedGoogle Scholar
  2. 2.
    Cunningham JD, Weiss SE, Ahmed S, et al. The efficacy of neoadjuvant chemotherapy compared to postoperative therapy in the treatment of locally advanced breast cancer. Cancer Invest. 1998;16:80–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16:2672–85.PubMedGoogle Scholar
  4. 4.
    Lippman ME, Sorace RA, Bagley CS, et al. Treatment of locally advanced breast cancer using primary induction chemotherapy with hormonal synchronization followed by radiation therapy with or without debulking surgery. NCI Monogr. 1986;1:153–9.PubMedGoogle Scholar
  5. 5.
    Haagensen CD, Stout A. Carcinoma of the breast. II. Criteria of operability. Ann Surg. 1943;20108:859.Google Scholar
  6. 6.
    Hortobagyi GN, Ames FC, Buzdar AU, et al. Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy. Cancer. 1988;62:2507–16.PubMedCrossRefGoogle Scholar
  7. 7.
    Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24, 740 breast cancer cases. Cancer. 1989;63:181–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Koscielny S, Tubiana M, Le MG, et al. Breast cancer: relationship between the size of the primary tumour and the probability of metastatic dissemination. Br J Cancer. 1984;49:709–15.PubMedCrossRefGoogle Scholar
  9. 9.
    Bonadonna G, Valagussa P, Zucali R, et al. Primary chemotherapy in surgically resectable breast cancer. CA Cancer J Clin. 1995;45:227–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Jacquillat C, Weil M, Baillet F, et al. Results of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer. 1990;66:20109–29.Google Scholar
  11. 2010.
    Bonadonna G, Valagussa P, Brambilla C, et al. Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol. 1998;16:93–100.PubMedGoogle Scholar
  12. 12.
    Kuerer HM, Newman LA, Smith TL, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17:460–9.PubMedGoogle Scholar
  13. 13.
    Peintinger F, Kuerer HM, Anderson K, et al. Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol. 2006;13(2010):1443–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Abraham DC, Jones RC, Jones SE, et al. Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging. Cancer. 1996;78:91–100.PubMedCrossRefGoogle Scholar
  15. 15.
    Esserman L, Hylton N, Yassa L, Barclay J, et al. Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol. 1999;17:20100–9.Google Scholar
  16. 16.
    Yeh E, Slanetz P, Kopans DB, et al. Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 2005;184(3):868–77.PubMedGoogle Scholar
  17. 17.
    Kuerer HM, Newman LA, Buzdar AU, et al. Residual metastatic axillary lymph nodes following neoadjuvant chemotherapy predict disease-free survival in patients with locally advanced breast cancer. Am J Surg. 1998;176:502–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Rouzier R, Pusztai L, Garbay JR, et al. Development and validation of nomograms for predicting residual tumor size and the probability of successful conservative surgery with neoadjuvant chemotherapy for breast cancer. Cancer. 2006;107(7):1459–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Balch CM, Singletary SE, Bland KI. Clinical decision-making in early breast cancer. Ann Surg. 1993;217:207–25.PubMedGoogle Scholar
  20. 20.
    Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Veronesi U, Luini A, Del Vecchio M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993;328:1587–91.PubMedCrossRefGoogle Scholar
  22. 22.
    Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy. Cancer. 2005;103(4):689–95.PubMedCrossRefGoogle Scholar
  23. 23.
    Hortobagyi GN. Multidisciplinary management of advanced primary and metastatic breast cancer. Cancer. 1994;74:416–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Buzdar AU, Valero V, Ibrahim NK, et al. Neoadjuvant therapy with paclitaxel followed by 5-fluorouracil, epirubicin, and cyclophosphamide chemotherapy and concurrent trastuzumab in human epidermal growth factor receptor 2-positive operable breast cancer: an update of the initial randomized study population and data of additional patients treated with the same regimen. Clin Cancer Res. 2007;13(1):228–33.PubMedCrossRefGoogle Scholar
  25. 25.
    Mazouni C, Kau SW, Frye D, et al. Inclusion of taxanes, particularly weekly paclitaxel, in preoperative chemotherapy improves pathologic complete response rate in estrogen receptor-positive breast cancers. Ann Oncol. 2007;18(5):874–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Boughey JC, Peintinger F, Meric-Bernstam F, Perry AC, Hunt KK, Babiera GV, et al. Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg. 2006;244(3):464–70.PubMedGoogle Scholar
  27. 27.
    Bedrosian I, Reynolds C, Mick R, et al. Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors. Cancer. 2000;88:2540–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Chung MH, Ye W, Giuliano AE. Role for sentinel lymph node dissection in the management of large (> or = 5 cm) invasive breast cancer. Ann Surg Oncol. 2001;8:688–92.PubMedGoogle Scholar
  29. 29.
    Sabel MS, Schott AF, Kleer CG, et al. Sentinel node biopsy prior to neoadjuvant chemotherapy. Am J Surg. 2003;186:102–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Kuerer HM, Sahin A, Hunt KK, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases prior to surgery in patients treated with neoadjuvant chemotherapy. Ann Surg. 1999;230:72–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol. 2000;18:3480–6.PubMedGoogle Scholar
  32. 32.
    Mamounas EP. Sentinel lymph node biopsy after neoadjuvant systemic therapy. Surg Clin North Am. 2003;83:931–42.PubMedCrossRefGoogle Scholar

Copyright information

© Springer New York 2010

Authors and Affiliations

  1. 1.Department of Surgical OncologyUniversity of Texas M. D. Anderson Cancer Center, University of TexasHoustonUSA

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