Scientific basis of neoadjuvant therapy

Neoadjuvant therapy includes systemic chemotherapy or radiotherapy for cancer before surgery. Neoadjuvant agents may be chemotherapeutic or hormonal agents, biological response modifiers, or future genetic manipulations. Neoadjuvant therapy in breast cancer began with attempts to improve advanced local or regional disease, but it is now used in larger but operable disease and is employed in earlier operable cancers. The goals of neoadjuvant therapy included conversion of inoperable to operable disease but evolved to increase rates of breast conservation. It allows direct observation of chemotherapeutic effects and more sophisticated prognostication based on pathological analysis of response extent. Patients even with advanced or inflammatory breast cancer may have excellent long-term disease-free survival and breast conservation. Expanded research opportunities may arise from the study of cancer features before and after neoadjuvant therapy contrasting responders with nonresponders. Neoadjuvant therapy demonstrates the advantages of comprehensive multidisciplinary contemporary patient management for function preservation and cosmetic appearance without sacrificing survival.