Omitting Surgery in Complete Responders After Neoadjuvant Chemotherapy: The Quest Continues

Excerpt

Use of neoadjuvant chemotherapy (NAC) has expanded over the past several years and is currently considered an alternative to adjuvant chemotherapy for selected patients with operable breast cancer.1 Development of more active NAC regimens (with or without addition of biologics) and improvements in patient selection for NAC based on tumor subtype have resulted in increasing rates of pathologic complete response (pCR) in the breast and axilla.1 In addition, improvements in breast imaging have enhanced our ability to identify preoperatively patients who are likely to have achieved pCR following NAC. For such patients, an emerging but yet unanswered question is whether formal surgical resection of the area of the tumor bed in the breast is necessary as part of breast-conserving therapy or whether it could safely be omitted. Before the question of omission of formal surgical resection in the breast can be addressed, studies have to identify a reliable and reproducible approach by which patients at high likelihood of pCR can be identified preoperatively. …