Onkológia 2/2017

Significance of neoadjuvant treatment in patients with early breast cancer – perspective of surgeon

Neoadjuvant chemoterapy (NAC) was originally designed to be used in patients with inflammatory and locally advanced breast cancer in order to convert inoperabile into operable tumors. Neoadjuvant chemoterapy increases the rate of breast-conserving surgeries in patients with operable disease who required mastectomy with no adverse impact on overall survival or locoregional recurrence. Patients with chemoresponsive breast cancers have benefit from this treatment. Of all clinical breast cancer subtypes human epidermal growth factor receptor 2 (HER2) positive breast cancer and triple-negative breast cancer are the most chemosensitive, and therefore are most amenable to neoadjuvant chemotherapy. Important steps are required from the time of diagnosis until the time of surgical resection. They include accurate assessment of the location and extend of the primary breast tumor and determination of axillary nodal status before and after NAC. The status of lymph nodes after therapy is the most important prognostic factor. Performing sentinel lymph node biopsy after NAC for patients with clinically negative axilla at the time of diagnosis is an acceptable approach. Neoadjuvant chemotherapy can convert clinically node-positive patients to pathologically node-negative status. Patients with residual tumor in lymph nodes have worse prognosis.

Keywords: breast cancer, neoadjuvant chemotherapy, breast conserving surgery, sentinel node biopsy