The significance of pre-operative chemotherapy:
The purpose is to shrink tumor size, lower tumor stage, so that non-surgical resection of locally advanced patients can gain more opportunities for breast-conserving surgery, but also play a role in vivo sensitivity test may be based on evaluation of surgery to remove the tumor specimens before the effect of chemotherapy, as surgery or recurrence of reference for the selection of chemotherapy regimens.
Overall results showed that preoperative neoadjuvant chemotherapy and postoperative adjuvant chemotherapy did not improve survival compared to. However, patients receiving neoadjuvant chemotherapy for breast-conserving surgery more opportunities. Neoadjuvant therapy was pathological complete remission (pCR) in patients with pCR compared with patients without a longer survival time.
The new indication for adjuvant therapy is not suitable for surgery of locally advanced breast cancer (T3 or N2 and above), there is conserving some of the wishes of patients with T2 (the primary tumor 3-5cm), while the primary tumor less than 3cm in axillary node-negative only in clinical studies in patients with early adoption of a new adjuvant therapy.
Pre-treatment must be clear pathological diagnosis and staging, treatment, pre-primary tumor core needle biopsy to determine the tumor ER, PR and Her-2 status.
Clinical examination of axillary lymph node-positive patients, needle biopsy should be a clear diagnosis; such as puncture-negative, or in patients with negative clinical examination should be a new adjuvant therapy ahead sentinel lymph node biopsy.
Neoadjuvant anthracycline-containing chemotherapy regimen recommended classes and taxane drugs program, you can use the joint can also be sequential.
ER and / or PR-positive elderly patients with poor general not suitable for chemotherapy patients, could be considered neo-adjuvant endocrine therapy.
HER-2 positive patients could be considered the treatment with Herceptin.
Number of cycles of neoadjuvant treatment should be based on different stage of disease and therapeutic purposes may be. Rigorous evaluation in determining the efficacy of follow-up treatment is very important. Is generally believed that each cycle should check physical understanding of changes in tumor size, two cycles imaging (B-ultrasound and X ray) to evaluate the clinical efficacy of 3-4-cycle next step be decided according to Evaluation of treatment, if necessary, through the puncture understanding of pathological change. Reach clinical efficacy in patients with CR or PR should continue to the original proposal to six cycles; efficacy of patients who respond poorly to consider changing the treatment plan, such as the replacement of drug treatment programs, to give up breast-conserving diverted to such radical surgery or radiotherapy.
In patients with locally advanced a new and effective adjuvant therapy, the usual options (modified) radical mastectomy; new adjuvant therapy for breast should be preserved, but the larger the primary tumor before treatment, or axillary node-positive patients choose breast-conserving surgery should be careful.
Neoadjuvant treatment of postoperative adjuvant therapy, should be noted that during surgery in patients with stage has changed, so should be based on neo-adjuvant pre-treatment stage to determine whether adjuvant radiotherapy. Adjuvant therapy in patients with hormone responsive to endocrine therapy. The new adjuvant therapy after adjuvant therapy for patients below the pCR, they have to take into account individual.
Now the former New adjuvant therapy for breast cancer surgery carried out more and more widely, but the new adjuvant therapy there are many issues to be resolved, such as the best drug programs and medication cycles, and reasonable efficacy evaluation tools and accurate timing of surgery, different effects postoperative treatment of patients and so on. Focus of future research is to better determine what the real from the new adjuvant therapy in patients with the greatest benefit.
