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Home Treatment Options Overview NEO-ADJUVANT CHEMOTHERAPY IN BREAST CANCER(Chemotherapy before Breast Surgery)

NEO-ADJUVANT CHEMOTHERAPY IN BREAST CANCER(Chemotherapy before Breast Surgery)

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NEO-ADJUVANT CHEMOTHERAPY IN BREAST CANCER(Chemotherapy before Breast Surgery)

1)Why do i need chemotherapy before surgery?

Chemotherapy given before surgery to promote breast conservation is called neo-adjuvant chemotherapy. You need neo-adjuvant chemotherapy to decrease the size of the tumor so that inoperable breast mass can become operable and a mastectomy could be converted to breast conservation therapy. For inoperable or inflammatory locally advanced cancers, chemotherapy prior to surgery (neo-adjuvant) is the standard of care.

2)I have seen patients get surgery first and then chemotherapy. Does that apply to me?

Chemotherapy given after surgery to kill residual microscopic cancer cells is called adjuvant chemotherapy. Adjuvant chemotherapy can be given in various forms such as radiation therapy, hormone therapy, chemotherapy and immunotherapy. Neo-adjuvant and adjuvant chemotherapy come with their own benefits and side effects. The current research is leading towards neo-adjuvant chemotherapy due to its multiple benefits. However, multiple studies have revealed that there is no significant difference in overall survival between patients who receive neo-adjuvant versus adjuvant chemotherapy.

Talk to your doctor about which type of chemotherapy will work in your individual case.

3)How long before i would expect the surgery to take place?

There are several factors that come in to play when deciding about timing of surgery. It depends upon tumor type, type of neo-adjuvant chemotherapy selected, your over all health, complications during the treatment and most importantly your preference. Hence, timing of surgery varies with every patient. Throughout your neo-adjuvant chemotherapy, you will be clinically assessed and periodic imaging will be done to assess the breast mass.

For example, patients with HER-2 positive breast cancer get chemotherapy(transtuzumab) for 6 months prior to the surgery. Chemotherapy is continued for 6 months after the surgery.

4) What do you mean by pathological complete response(pCR)? Why is it good for me to know?

Pathological complete response is the absence of any residual cancer cells in the breast tissue removed during surgery after neo-adjuvant chemotherapy has been given.

It is good for you to know as pathological complete response has been linked directly with overall survival. There was a study called National Surgical Adjuvant Breast and Bowel Project B-18 which showed that patients who achieved pathological complete survival after neo-adjuvant chemotherapy had superior disease free survival and overall survival compared to patients who had the surgery followed by chemotherapy.

5)Besides saving my breast from mastectomy, are there other advantages of neo-adjuvant chemotherapy?

Neo-adjuvant chemotherapy has multiple advantages:

-converting inoperable breast tumors to operable tumors,

-observe direct and early response to treatment,

-proving effectiveness of chosen treatment

-Information on the outcome depending on pathological complete response may help in converting an ineffective treatment to an effective one.

-In locally advanced tumors with high metastatic potential, neo-adjuvant chemotherapy offers the possibility to treat both primary lesions and micro metastasis at distant sites.

6)I know people get chemotherapy, why are you suggesting i take hormonal therapy?

Some cancer cells multiply in the presence of hormones like estrogen, progesterone. We have treatments which block the action of these hormones on breast tissue and thus treating the cancer.

For example, in premenopausal women we give tamoxifen which blocks the effect of estrogen on breast tissue. Postmenopausal women are given medications called aromatase inhibitors which have more benefits and fewer side effects than tamoxifen. They prevent the conversion of androgens to estrogen in fat cells.

7)Is there any evidence that doing this chemotherapy benefits me long term besides offering me a chance to conserve my breast?

Pathological complete response measured after neo-adjuvant chemotherapy has been directly linked to disease free survival, long term survival and event free survival. It is of most benefit in aggressive tumors. It is also a predictor of whether the breast cancer will recur or not.

8)My doctor said i have low recurrence score and do not need chemotherapy. How can you explain that?

Oncotype Dx is the most common test used to evaluate your recurrence score. It looks into the genes in the cancer cells and predicts how the cells will behave. In other words, it predicts the chance of your breast cancer coming back after the treatment for your breast cancer is complete. When your recurrence score is low, i.e. less than 18, it means that the chance of cancer coming back is low and chemotherapy will not be effective in decreasing cancer recurrence.

Whereas when your recurrence score is high, chemotherapy will be given as it may decrease the chances of the breast cancer coming back.

Chemotherapy itself has multiple side effects depending on the medications used and its judicious use is possible by calculating recurrence score.

RADHIKA CHATURVEDI HULIYAR,MD

PGY-2

Internal Medicine

 

Maricopa Medical Center