Neoadjuvant (Preoperative) Therapy in Breast Cancer
نویسندگان
چکیده
Locally advanced breast cancer (LABC) occurs at presentation in approximately 20-25% of breast cancer patients worldwide, but significantly less in countries with implemented screening programs. LABC refers to large operable (stage IIB, IIIA) or inoperable (stage IIIB, IIIC) tumors, including inflammatory breast cancer. Patients with ipsilateral supraclavicular lymph node involvement previously considered as having metastatic disease are now also included in the category of LABC (stage IIIC). Treatment of LABC has evolved within recent decades. For a long time, mastectomy remained the mainstay of treatment in this group of patients, but long-term local control was disappointingly low, with approximately 50% local recurrences (LR) and only 2% 5-year overall survival (OS). Implementation of postoperative radiotherapy increased local control and survival, but long-term outcomes remained unsat‐ isfactory (35-55% LR and 25-45% five-year OS). Incorporating systemic therapy (be it chemo‐ therapy, hormonal therapy or both) as an adjunct to surgery and/or radiotherapy further improved results. Currently, a combination of systemic therapy with locoregional treatment (surgery and/or radiotherapy) constitutes the standard of care in LABC patients since im‐ proving locoregional control is associated with better survival. In patients with stage III breast cancer treated with induction chemotherapy followed by surgery, radiotherapy or a combination thereof, the risk of loco regional recurrence is in the range of 20%. The use of induction systemic therapy results in tumor downstaging, and in selected LABC patients even allows for breast conserving surgery (BCS). However, the safety and efficacy of this ap‐ proach in LABC have not been verified in randomized studies. Even though locoregional management is an important component of multimodality treatment in patients with LABC, the pattern of local management and factors influencing local treatment strategy in this group are not well recognized (Sinacki et al., 2011). Neoadjuvant therapy is recommended not only for locally advanced and inflammatory breast cancer but also as an option for pri‐ mary operable disease without compromising long-term outcome (Untch et al., 2011).
منابع مشابه
Dissection axillary lymph node count in patient with breast cancer followed by neoadjuvant therapy
Introduction: Breast cancer is the most common cancer and the second cause of death in women. It is essential to have the highest level of confidence in axillary staging assessment. Many surgeons and pathologists believe that fewer lymph nodes are present in axillary dissection specimens of women treated by neoadjuvant chemotherapy. Consequently, the purpose of this study was to compare the lym...
متن کاملPrognostic Significance of Reduction in Ki67 Index After Neoadjuvant Chemotherapy in Patients With Breast Cancer in Kerman Between 2009 And 2014
Background and objective:Breast cancer is the most common malignancy among women. The Neoadjuvant chemotherapy is the treatment of choice for non-operable tumors. The Ki67 is a proliferation marker that can be used to predict the therapeutic response to chemotherapy and the patients' prognosis. Methods: This retrospective study was carri...
متن کاملRecent Advances in the Neoadjuvant Treatment of Breast Cancer
In the last few decades, neoadjuvant therapy for breast cancer has gained considerable therapeutic importance. Despite extensive clinical investigations, it has not yet been clarified whether neoadjuvant therapy would result in improved survival in comparison with the standard adjuvant setting in any subgroups of patients with breast cancer. Chemotherapy is especially effective in the treatment...
متن کاملNeoadjuvant treatment of breast cancer.
Neoadjuvant treatment of breast cancer has become established as the safe and often effective therapeutic approach of choice for larger primary and for locally advanced breast cancer. The neoadjuvant approach offers the advantages of downstaging the disease, potentially reducing the extent of surgery and in an era of individualization of therapy, testing the efficacy of therapy administered to ...
متن کاملNeoadjuvant systemic therapy and the surgical management of breast cancer.
Neoadjuvant chemotherapy is standard management for women who have locally advanced or inflammatory breast cancer, but can be applied to all women who may require postoperative chemotherapy for early-stage breast cancer. Disease-free survival and overall survival are equivalent between patients treated with neoadjuvant chemotherapy and patients treated with the same regimen postoperatively. Pre...
متن کاملPreoperative endocrine therapy for breast cancer.
The preoperative use of systemic therapy for primary breast cancer has the potential to downstage tumours. This would render suitable for breast conservation some tumours that were unsuitable at initial presentation, or would convert some inoperable locally advanced breast cancers into tumours that are operable. No survival benefit has been demonstrated for neoadjuvant chemotherapy compared wit...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره شماره
صفحات -
تاریخ انتشار 2013