Neoadjuvant chemotherapy for early breast cancer.
BACKGROUND
Neoadjuvant chemotherapy defines the preoperative administration of systemic therapy in order to downstage the primary tumor and affected lymph nodes to improve the surgical approach. Neoadjuvant chemotherapy is increasingly being used in the treatment of early operable breast cancer.


OBJECTIVE
We reviewed the available data of neoadjuvant chemotherapy with emphasis on tumor response assessment and prediction, and locoregional management.


METHODS
We searched the databases of MEDLINE and EMBASE using the search terms breast cancer, neoadjuvant or preoperative or primary or induction, and chemotherapy from 1950 to 1 March 2009.


CONCLUSIONS
Compared with adjuvant chemotherapy, neoadjuvant chemotherapy increases breast conservation with equal survival and locoregional control. Tumor response assessment during neoadjuvant chemotherapy allows identification of in vivo tumor sensitivity to different agents which will help determine predictive factors for improved selection criteria. Randomized trials assessing the timing of sentinel lymph node biopsy in initially lymph node positive patients are warranted. In the near future, intraoperative fluorescent imaging and targeting of cancer stem cells will become important avenues of research.
Mieog
J Sven D
JS
Leiden University Medical Centre Department of Surgery, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
van de Velde
Cornelis J H
CJ
D000818:Animals; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods