Integration of neoadjuvant systemic therapy into surgical practice

In breast cancer, the use of postoperative, or adjuvant, chemotherapy is inextricably linked to the improved outcomes seen over the past several decades. Neoadjuvant chemotherapy has become the standard of care for patients with locally advanced breast cancer and has rapidly come to the forefront among potential treatments for patients with earlier-stage operable disease. Several studies have shown that breast cancer patients treated with neoadjuvant chemotherapy do not necessarily survive longer than those treated with conventional postoperative adjuvant chemotherapy; however, the use of neoadjuvant chemotherapy has several proven and theoretical advantages. This chapter reviews the potential merits of neoadjuvant therapy as it applies to breast cancer care in general, and breast surgery in particular.