Breakthrough for neoadjuvant chemotherapy

Primary breast cancer is considered today as a systemic disease with a locoregional component. Systemic treatment is therefore, considered as a fundamental component of the medical management of patients suffering from this endemic malignancy. Postoperative application of chemo-, endocrine or immunological therapies are always lacking the control of efficacy at the short term. On the other hand preoperative treatment allows the assessment of efficacy at “real time” by physical examination, breast ultrasound or mammography as well by histopathology of the surgically removed involved tissue. According to a so far not sufficiently proven hypothesis response of locoregional disease correlates to an elimination of a distant micrometastatic disease. As at least equal efficacy for pre- and postoperative application of chemotherapy has been shown for a variety of cytotoxic treatments, preoperative chemotherapy is widely accepted today as an option to reduce the extent of surgery, to obtain freedom from locoregional and distant disease as well as to obtain early information on tumor responsiveness.