[Role of radiation therapy on the use of primary ("neoadjuvant") systemic treatment of breast cancer].
BACKGROUND
The indications for primary ("neoadjuvant") systemic treatment (PST) for breast cancer have evolved over the last few years. PST is not only used in patients with locally advanced breast cancer (LABC) and inoperable tumors but also plays a role for operable tumors aiming at breast conservation and higher complete remission rates (ypCR). The contribution of radiotherapy and the optimal sequencing of chemotherapy, surgery and radiotherapy still have to be defined.


METHODS
Objectives and results of PST for inflammatory, locally advanced and operable breast cancer were analyzed according to tumor stage.


RESULTS
Radiotherapy following PST and surgery is the standard of care for inflammatory breast cancer, LABC and nonresectable lesions. Comparable results are achieved for good responders after PST receiving radiotherapy or surgery. The evaluation of a preoperative radiotherapeutic approach is complicated by different chemo- and radiotherapy regimens, continuation of chemotherapy after surgery and heterogeneous patient groups.


CONCLUSIONS
For LABC and inflammatory breast cancer the role of PST is well defined. For operable lesions, however, the value of preoperative radiotherapy still has to be established. This should be assessed within the framework of a clinical trial using standardized parameters for applying chemotherapy as well as radiation therapy.
Souchon
Rainer
R
Klinik für Strahlentherapie und Radioonkologie, Allgemeines Krankenhaus Hagen gGmbH, Grunstrasse 35, 58095 Hagen. souchon@akh-hagen.de
Dunst
Jürgen
J
Hartmann
Karl Axel
KA
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017322:Clinical Trials, Phase II as Topic; D018572:Disease-Free Survival; D005260:Female; D005544:Forecasting; D006801:Humans; D015411:Mastectomy, Modified Radical; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011182:Postoperative Care; D017697:Premenopause; D011300:Preoperative Care; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D016896:Treatment Outcome
D000970:Antineoplastic Agents