Neoadjuvant chemotherapy for breast carcinoma: multidisciplinary considerations of benefits and risks

BACKGROUND: The majority of patients with breast carcinoma receive chemotherapy as a component of multimodality treatment. Over the past decade, it has become increasingly more common to deliver chemotherapy first, but this has raised new questions within all disciplines of cancer management. METHODS: The authors reviewed published studies on the effect of neoadjuvant chemotherapy for breast carcinoma on the practice of medical oncology, surgical oncology, radiation oncology, pathology, and radiology. RESULTS: Treating breast carcinoma with neoadjuvant chemotherapy has several advantages, such as providing the earliest possible treatment against preexisting micrometastases, offering selected patients breast conservation therapy, and allowing for measurement of disease response, which can then be used to customize subsequent chemotherapy. However, neoadjuvant chemotherapy affects the practice not only of medical oncology, but also has important implications for the specialties of surgery, radiology, pathology, and radiation oncology. The current review addressed the new opportunities and challenges within the multidisciplinary care of breast carcinoma provided by neoadjuvant chemotherapy. CONCLUSIONS: The complexity of the issues led the authors to conclude that patients who receive neoadjuvant chemotherapy are likely to benefit from a coordinated multidisciplinary approach to their care.