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Text
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URL Address
<a href="http://doi.org/10.1200/jco.2007.15.0326" target="_blank" rel="noreferrer noopener">http://doi.org/10.1200/jco.2007.15.0326</a>
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Pages
791-797
Issue
5
Volume
26
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Title
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Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: A National Cancer Institute conference
Publisher
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Journal of Clinical Oncology
Date
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2008
2008-02
Subject
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Oncology; reconstruction; neoadjuvant chemotherapy; mastectomy; lymph-node biopsy; mri; b-27; local-regional recurrence; pathological tumor size; postmastectomy radiation improves; project protocol; surgical adjuvant breast
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Buchholz T A; Lehman C D; Harris J R; Pockaj B A; Khouri N; Hylton N F; Miller M J; Whelan T; Pierce L J; Esserman L J; Newman L A; Smith B L; Bear H D; Mamounas E P
Description
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Purpose 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. Conclusion 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.
Identifier
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<a href="http://doi.org/10.1200/jco.2007.15.0326" target="_blank" rel="noreferrer noopener">10.1200/jco.2007.15.0326</a>
Format
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Journal Article or Conference Abstract Publication
2008
b-27
Bear H D
Buchholz T A
Esserman L J
Harris J R
Hylton N F
Journal Article or Conference Abstract Publication
Journal of Clinical Oncology
Khouri N
Lehman C D
local-regional recurrence
lymph-node biopsy
Mamounas E P
Mastectomy
Miller M J
MRI
neoadjuvant chemotherapy
Newman L A
oncology
pathological tumor size
Pierce L J
Pockaj B A
postmastectomy radiation improves
project protocol
reconstruction
Smith B L
surgical adjuvant breast
Whelan T