Dose-Intense Adjuvant Treatment of High-Risk Breast Cancer

Abstract

During the past two decades, we have witnessed a dramatic revolution in the strategic approach for primary breast cancer. The introduction of systemic adjuvant therapy was considered conceptually important in given high-risk subsets to control and, if possible, to eradicate distant micrometastases that were responsible for the failure of local-regional therapy, regardless of the extent of surgery and the intensity of radiation (1). For the same biologic and clinical reasons that indicate the prevalent systemic nature of this complex disease, surgeons (2,3) decided to test conservative versus mutilating procedures in small breast tumors. The 5to 10-year results of prospective randomized trials have successfully validated the proposed alternative hypothesis. Systemic adjuvant therapy can significantly improve relapse-free and total survival in given subsets of patients (4). Mutilating surgery is an unnecessary procedure in the treatment of breast tumors less than 4 cm at their largest diameter. These important achievements have further stimulated laboratory and clinical investigators to improve their selection of candidate patients for systemic adjuvant therapy, to intensify treatment in the poor-risk subsets, and to increase the frequency of breast-saving procedures by primary (neoadjuvant) chemotherapy.