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Preoperative chemotherapy is a safe
procedure for patients with early breast cancer
Patients
with early breast cancer are treated with local therapy with or without
systemic therapy. Systemic treatment improves disease free and overall
survival and can be administrated before (neoadjuvant, preoperative,
primary) or after (adjuvant, postoperative) local therapy. In the last
century, several trials were initiated to compare preoperative
chemotherapy to postoperative chemotherapy. None of these trials found a
survival advantage for preoperative chemotherapy. One of these trials
was the
European
Organization for Research and Treatment of Cancer (EORTC) 10902, or the
Preoperative Chemotherapy in Operable Breast Cancer (POCOB) trial. The
10 years follow-up data were recently published in the Breast Cancer
Research and Treatment.
Although, preoperative chemotherapy does not improve survival compared
to postoperative chemotherapy, it is correlated with several potential
advantages. First the ability to monitor treatment efficacy in vivo with
the possibility to make appropriate changes in case of drug resistance.
Second, it allows downsizing of tumours, making ineligible patients
eligible for breast conserving therapy which results in a increased rate
of breast conserving therapy. Moreover, there is no significant increase
of locoregional recurrence rate if surgery is not omitted (surgery
should always be part of local treatment, also in case of a complete
response). This implies that tumour downsizing followed by breast
conserving therapy is permitted and a safe procedure. Third it allows
downstaging, preventing unnecessary axillary lymph node dissection
procedures. Fourth,
preoperative treatment is the keystone for translational research
Bibliographic Reference
Van Nes JG et al.: "Preoperative chemotherapy is safe in early breast cancer,
even after 10 years of follow-up; clinical and translational results from
the EORTC trial 10902", Breast Cancer Res Treat. 2008 May 18. [Epub ahead of
print])
Janine van Nes
Department of Surgery, Leiden
University Medical Centre, Leiden, the Netherlands
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