Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference.
OBJECTIVE
To review the state of the science with respect to diagnostic imaging and locoregional therapy for patients with breast cancer receiving preoperative chemotherapy.


METHODS
Published data relevant to clinical staging, monitoring of tumor response, and locoregional therapy for patients with breast cancer treated with preoperative chemotherapy were reviewed.


RESULTS
High-quality data from prospective randomized trials are limited. Available data suggest that locoregional therapy decisions should be based on both the pretreatment clinical extent of disease and the pathologic extent of the disease after chemotherapy. Accordingly, physical examination and imaging studies that accurately define the initial extent of disease are required before treatment. Sentinel lymph node biopsy can be performed either before or after preoperative chemotherapy for patients with clinical N0 disease. The success of breast conservation after preoperative chemotherapy depends on careful patient selection and achieving negative surgical margins. Adjuvant breast radiation is indicated for all patients treated with breast conservation. For patients treated with mastectomy, chest-wall and regional nodal radiation should be considered for those who present with clinical stage III disease or have histologically positive lymph nodes after preoperative chemotherapy. Additional prospective studies are needed to determine the value of postmastectomy radiation for patients with stage II breast cancer who have negative lymph nodes after chemotherapy.


CONCLUSIONS
The increased use of preoperative chemotherapy has raised new questions concerning the optimal methods to stage and monitor disease response to treatment and how to optimize locoregional treatment. The available evidence suggests that a multidisciplinary approach improves outcomes.
Buchholz
Thomas A
TA
Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcolmbe Blvd, Unit 1202, Houston, TX 77030, USA. tbuchhol@mdanderson.org
Lehman
Constance D
CD
Harris
Jay R
JR
Pockaj
Barbara A
BA
Khouri
Nagi
N
Hylton
Nola F
NF
Miller
Michael J
MJ
Whelan
Timothy
T
Pierce
Lori J
LJ
Esserman
Laura J
LJ
Newman
Lisa A
LA
Smith
Barbara L
BL
Bear
Harry D
HD
Mamounas
Eleftherios P
EP
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D003226:Congresses as Topic; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015412:Mastectomy, Segmental; D054547:National Cancer Institute (U.S.); D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D021701:Sentinel Lymph Node Biopsy; D013997:Time Factors; D014481:United States
D000970:Antineoplastic Agents