Assisting Community-Based Oncologists and Surgeons in Making Neoadjuvant Treatment Decisions for Patients with Early Breast CancerNeoadjuvant treatment and local disease control
1:18 minutes.
TRANSCRIPTION:
DR MAMOUNAS: The way I think about it, is, you are going to need chemotherapy anyways. What are the advantages of doing it before? And the advantages are that you could potentially affect local-regional endpoints, meaning that you can convert somebody with a mastectomy candidate to lumpectomy candidate. You can confirm a lumpectomy candidate to a better lumpectomy candidate. And what I mean by that is removing less tissue, making the cosmetic effect of surgery better. Also, you have to look not only at the breast, but you also look at the axilla. Even somebody with clinically negative nodes potentially could have positive nodes when it goes to surgery. So the chance that you potentially will do an axillary dissection is higher if you do surgery first than if, potentially, you do neoadjuvant chemotherapy, downstage the axilla and potentially offer them a lesser procedure, like sentinel node biopsy. So I look at it in these 2 terms, in terms of surgery. And then lastly, I also look at it in terms of the potential for radiotherapy. If somebody has positive nodes or positive margins, the need for radiotherapy is there. Potentially, you can downstage them and tailor the extent of radiotherapy. Now, this is a research question that we actually are looking at a clinical trial now that’s currently ongoing. But I think along those lines too, and I talk to the patient. “There’s a potential, not only tailoring the surgery, but potentially tailoring radiotherapy.” |