title: Preoperative systemic therapy in locoregional management of early breast cancer: highlights from the Kyoto Breast Cancer Consensus Conference.
abstract: Data reviewed at the Kyoto Breast Cancer Consensus Conference (KBCCC) showed that preoperative systemic therapy (PST) could optimize surgery through the utilization of information relating to pre- and post-PST tumor stage, therapeutic sensitivity, and treatment-induced changes in the biological characteristics of the tumor. As such, it was noted that the biological characteristics of the tumor, such as hormone receptors, human epidermal growth factor receptor-2, histological grade, cell proliferative activity, mainly defined by the Ki67 labeling index, and the tumor's multi-gene signature, should be considered in the planning of both systemic and local therapy. Furthermore, the timing of axillary sentinel lymph node diagnosis (i.e., before or after the PST) was also noted to be critical in that it may influence the likelihood of axillary preservation, even in node positive cases. In addition, axillary diagnosis with ultrasound and concomitant fine needle aspiration cytology or core needle biopsy (CNB) was reported to contribute to the construction of a treatment algorithm for patient-specific or individualized axillary surgery. Following PST, planning for breast surgery should therefore be based on tumor subtype, tumor volume and extent, therapeutic response to PST, and patient preference. Nomograms for predicting nodal status and drug sensitivity were also recognized as a tool to support decision-making in the selection of surgical treatment. Overall, review of data at the KBCCC showed that PST increases the likelihood of patients receiving localized surgery and individualized treatment regimens.
authors.affiliation: Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawara-cho, Sakyo-ku, Kyoto 606-8507, Japan. info@kyoto-breast-cancer.org
authors.forename: Masakazu
authors.initials: M
authors.lastname: Toi
authors.forename: John R
authors.initials: JR
authors.lastname: Benson
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: John F
authors.initials: JF
authors.lastname: Forbes
authors.forename: Gunter
authors.initials: G
authors.lastname: von Minckwitz
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.forename: John F R
authors.initials: JF
authors.lastname: Robertson
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Cole
authors.forename: Louis W C
authors.initials: LW
authors.lastname: Chow
authors.forename: Mark D
authors.initials: MD
authors.lastname: Pegram
authors.forename: Wonshik
authors.initials: W
authors.lastname: Han
authors.forename: Chiun-Sheng
authors.initials: CS
authors.lastname: Huang
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ikeda
authors.forename: Shotaro
authors.initials: S
authors.lastname: Kanao
authors.forename: Eun-Sook
authors.initials: ES
authors.lastname: Lee
authors.forename: Shinzaburo
authors.initials: S
authors.lastname: Noguchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohno
authors.forename: Ann H
authors.initials: AH
authors.lastname: Partridge
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Tozaki
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Sugie
authors.forename: Akira
authors.initials: A
authors.lastname: Yamauchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Inamoto
mesh_terms: D000465:Algorithms; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery* / Q000628:therapy*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D020360:Neoadjuvant Therapy; D049451:Nomograms; D011300:Preoperative Care; D021701:Sentinel Lymph Node Biopsy; D047368:Tumor Burden