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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2015

01-10-2015 | Breast Oncology

Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer

Authors: Dennis Holmes, MD, A. Colfry, MD, Brian Czerniecki, MD, Diana Dickson-Witmer, MD, C. Francisco Espinel, MD, Elizabeth Feldman, MD, Kristalyn Gallagher, DO, Rachel Greenup, MD, Virginia Herrmann, MD, Henry Kuerer, MD, Manmeet Malik, DO, Eric Manahan, MD, Jennifer O’Neill, MD, Mita Patel, MD, Molly Sebastian, MD, Amanda Wheeler, MD, Rena Kass, MD

Published in: Annals of Surgical Oncology | Issue 10/2015

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Abstract

Purpose

The American Society of Breast Surgeons (ASBrS) sought to provide an evidence-based guideline on the use of neoadjuvant systemic therapy (NST) in the management of clinical stage II and III invasive breast cancer.

Methods

A comprehensive nonsystematic review was performed of selected peer-reviewed literature published since 2000. The Education Committee of the ASBrS convened to develop guideline recommendations.

Results

A performance and practice guideline was prepared to outline the baseline assessment and perioperative management of patients with clinical stage II–III breast cancer under consideration for NST.

Recommendations

Preoperative or NST is emerging as an important initial strategy for the management of invasive breast cancer. From the surgeon’s perspective, the primary goal of NST is to increase the resectability of locally advanced breast cancer, increase the feasibility of breast-conserving surgery and sentinel node biopsy, and decrease surgical morbidity. To ensure optimal patient selection and efficient patient care, the guideline recommends: (1) baseline breast and axillary imaging; (2) minimally invasive biopsies of breast and axillary lesions; (3) determination of tumor biomarkers; (4) systemic staging; (5) care coordination, including referrals to medical oncology, radiation oncology, plastic surgery, social work, and genetic counseling, if indicated; (6) initiation of NST; (7) post-NST breast and axillary imaging; and (8) decision for surgery based on extent of disease at presentation, patient choice, clinical response to NST, and genetic testing results, if performed.
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Metadata
Title
Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer
Authors
Dennis Holmes, MD
A. Colfry, MD
Brian Czerniecki, MD
Diana Dickson-Witmer, MD
C. Francisco Espinel, MD
Elizabeth Feldman, MD
Kristalyn Gallagher, DO
Rachel Greenup, MD
Virginia Herrmann, MD
Henry Kuerer, MD
Manmeet Malik, DO
Eric Manahan, MD
Jennifer O’Neill, MD
Mita Patel, MD
Molly Sebastian, MD
Amanda Wheeler, MD
Rena Kass, MD
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4753-3

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