Breast-conserving surgery in the neoadjuvant setting.

The use of neoadjuvant chemotherapy for the treatment of patients with operable breast cancer remains controversial. Neoadjuvant chemotherapy is highly effective in achieving significant tumor regression. However, the primary goal of improved survival has yet to be clearly demonstrated. The largest prospective trial with adequate follow-up to report 5-year disease-free survival data demonstrated no significant difference between patients treated with neoadjuvant chemotherapy followed by locoregional treatment and locoregional treatment followed by adjuvant chemotherapy. Survival data from the National Surgical Adjuvant Breast and Bowel Project B-18 trial are not yet available. The potential impact on the breast conservation rate for patients with early operable breast cancer is small, and careful follow-up of the long-term risk of local recurrence for patients with neoadjuvant therapy induced downstaging followed by BCT is not yet available. At this time, neoadjuvant chemotherapy for the treatment of patients with operable breast cancer should be considered investigational.