Neoadjuvant chemotherapy came into vogue in the seventies and eighties, spurred on by the success of organ preservation strategies in cancers such as laryngeal and rectal cancer. It used to be thought there are two potential benefits of neoadjuvant chemotherapy: downstaging a breast tumor so lesser surgery can be performed – lumpectomy instead of mastectomy, and to potentially treat early occult metastatic disease and to improve survival. The first goal can be successfully accomplished as has has been corroborated by large randomized studies but the second goal has not been proven to be accomplished by neaodjuvant chemotherapy. In fact, studies do not show a that women live longer after neaodjuvant chemotherapy. However, more recently, with improving chemotherapy effectiveness, it became appreciated that response is a predictive tool that can be used to plan farther chemotherapy. The idea is the giving chemo first can identify patients who need a more aggressive approach. However, NCCN still only recommends neoadjuvant therapy for women in stage IIA or higher and who desire breast preservation.
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