Regional Nodal Management After Preoperative Systemic Therapy

Area of Science:

• Oncology
• Breast Cancer Research
• Neoadjuvant Therapy

Background:

• Historically, preoperative systemic therapy was limited to locally advanced breast cancer.
• Advances in understanding breast cancer biology have broadened its application.
• Current patient selection is guided by cancer subtype and targeted therapies.

Purpose of the Study:

• To review the current landscape of local therapy considerations after preoperative chemotherapy.
• To discuss future directions in managing breast and axilla after neoadjuvant treatment.
• To highlight the evolving role of systemic therapy in breast cancer management.

Main Methods:

• Review of current literature on neoadjuvant systemic therapy and its impact on local treatment.
• Analysis of evolving best practices in breast and axillary management post-chemotherapy.
• Discussion of tailored treatment approaches based on breast cancer subtypes (HER2+, triple-negative).

Main Results:

• Preoperative chemotherapy, including targeted agents and immunotherapy, has increased response rates.
• Benefits include tumor downstaging for breast conservation and potential de-escalation of axillary surgery/nodal radiation for pathologic complete response.
• Multidisciplinary approaches are crucial for implementing these strategies.

Conclusions:

• Preoperative systemic therapy is increasingly integral to breast cancer management, offering personalized treatment.
• It enables tailored local therapy, potentially reducing surgical and radiation burden.
• Evolving strategies necessitate a multidisciplinary approach to optimize outcomes.