[Neoadjuvant (preoperative) chemotherapy for resectable breast cancer]

Neoadjuvant (preoperative) chemotherapy (NACT) represents a novel approach based on sound theoretical, pharmacokinetic, and experimental principles. The purpose of NACT is to improve control of the primary site by stage reduction and/or to improve control of micro-metastatic disease. We showed in this paper that: 1) Intensive NACT is beneficial to most patients with infiltrative breast cancer. 2) The extent of surgery can be reduced by NACT, and may provide optimal local control with the possibility of breast conservation. 3) There is no evidence that cure or survival is altered by NACT, as compared with standard postoperative adjuvant therapy. 4) Evidence from all of these studies indicates the safety of NACT relative to overall systemic toxicity and local wound healing. In recent years, NACT has been tested in twelve patients with stage III and inflammatory breast cancer in our institute. The objective clinical response was as follows: complete response 0%, partial response 92%, no change 8%, progressive disease 0%. Projected disease-free survival was 51% and projected overall survival was 63% at 7 years. These reported results and our experience emphasize the important role of NACT in the management of breast cancer.