The principles of surgical treatment following the neoadjuvant chemotherapy in locally advanced breast cancer

Abstract

Neoadjuvant chemotherapy is one of the most important standard treatment strategies for patients with locally advanced breast cancer,which can improve resectability and the rate of breast conservation.For early-stage brest cancer,neoadjuvant therapy has down-staging effect and is helpful for chemosensitivity evaluation and individualized therapy.Several studies have shown that patient response is correlated with survival and many patients benefit from the control of occult micrometastases in distant organs by neoad-juvant chemotherapy.In this article,we review the progress in research about locally surgical treatment(breast-conserving surgery,immediate breast reconstruction and axillary lymph node dissection) after neoadjuvant chemotherapy.The breast-conserving surgery after neoadjuvant chemotherapy should not increase the risk of loco-regional recurrence or decrease the survival rate.The selection criteria applied in breast-conserving surgery decisions should be consistent with primary surgery or surgery after neoadjuvant chemotherapy.The breast-conserving surgery is safe for patients with a strong response to neoadjuvant chemotherapy,even if they present with locally advanced disease.Immediate breast reconstruction can be considered for LABC patients who recieved neoadjuvant chemotherapy,without increasing the rate of postoperative complications.Radiation can cause contractures or recurrent infection of breast prosthesis,but its effect on autologous breast has not been elucidated.So delayed breast reconstruction should be considered for LABC patients.The delayed-immediate breast reconstruction advanced by Kronowitz is a method of clinical vaule.For patients sensitive to neoadjuvant chemotherapy,axillary lymph node staging can be obtained through sentinel lymph node biopsy.The combination of ultrasound and SLNB to identify axillary lymph node status is recommended and warrants further study.