Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2007 Apr 18;2007(2):CD005002.
doi: 10.1002/14651858.CD005002.pub2.

Preoperative chemotherapy for women with operable breast cancer

J S D Mieog  1 , J A van der Hage, C J H van de Velde
Affiliations
Meta-Analysis

Preoperative chemotherapy for women with operable breast cancer

J S D Mieog et al. Cochrane Database Syst Rev. .

Abstract

Background: Currently, preoperative chemotherapy is the standard of care in locally advanced breast cancer to achieve local tumour downsizing in order to make surgery possible. Since the early 1980s, the role of preoperative chemotherapy in early stage (or operable) breast cancer has been the subject of study. Potential advantages are early introduction of systemic therapy, determination of chemosensitivity, reduction of tumour volume and downstaging of surgical requirement. Concerns exist about local control after downsized surgery and the delay of local treatment in patients with tumours resistant to chemotherapy.

Objectives: To assess the effectiveness of preoperative chemotherapy in women with operable breast cancer when compared to postoperative chemotherapy.

Search strategy: The Specialised Register maintained by the Editorial Base of the Cochrane Breast Cancer Group was searched on 4th of August 2005.

Selection criteria: Randomised trials comparing preoperative chemotherapy with postoperative in women with operable breast cancer.

Data collection and analysis: Studies were assessed for eligibility and quality, and data were extracted by two independent review authors. Hazard ratios were derived for time-to-event outcomes directly or indirectly using the methods described by Parmar. Relative risks were derived for dichotomous outcomes. Meta-analyses were performed using fixed effect model.

Main results: We identified 14 eligible studies which randomised a total of 5,500 women. Median follow-up ranged from 18 to 124 months. Eight studies described a satisfactory method of randomisation.Data, based on 1139 estimated deaths in 4620 women available for analysis, show equivalent overall survival rates with a HR of 0.98 (95% CI, 0.87 to 1.09; p, 0.67; no heterogeneity). Preoperative chemotherapy increases breast conservation rates, yet at the associated cost of increased loco regional recurrence rates. However, this rate was not increased as long as surgery remains part of the treatment even after complete tumour regression (HR, 1.12; 95% CI, 0.92 to 1.37; p, 0.25; no heterogeneity. Preoperative chemotherapy was associated with fewer adverse effects. Pathological complete response is associated with better survival than residual disease (HR, 0.48; 95% CI, 0.33 to 0.69; p, < 10-4).

Authors' conclusions: This review suggests safe application of preoperative chemotherapy in the treatment of women with early stage breast cancer in order to down-stage surgical requirement, to evaluate chemosensitivity and to facilitate translational research.

PubMed Disclaimer

Conflict of interest statement

CV and JH were involved in the EORTC 10902 study. None of the authors who contributed to this article have any financial or personal relationships with people or organisations that could inappropriately influence the data published.

Figures

1
1
2
2
Table 01.
3
3
Table 02.
4
4
Table 03.
5
5
Table 04.
6
6
7
7
8
8
9
9
10
10
1.1
1.1. Analysis
Comparison 1: Preoperative versus postoperative chemotherapy, Outcome 1: Overall survival
1.2
1.2. Analysis
Comparison 1: Preoperative versus postoperative chemotherapy, Outcome 2: Disease‐free survival
1.3
1.3. Analysis
Comparison 1: Preoperative versus postoperative chemotherapy, Outcome 3: Time to loco‐regional recurrence
1.4
1.4. Analysis
Comparison 1: Preoperative versus postoperative chemotherapy, Outcome 4: Loco‐regional treatment (mastectomy rate)
1.5
1.5. Analysis
Comparison 1: Preoperative versus postoperative chemotherapy, Outcome 5: Adverse effects
2.1
2.1. Analysis
Comparison 2: Pathological complete response (pCR) vs residual disease (pRES), Outcome 1: Overall survival
2.2
2.2. Analysis
Comparison 2: Pathological complete response (pCR) vs residual disease (pRES), Outcome 2: Disease‐free survival
3.1
3.1. Analysis
Comparison 3: Downstaged vs planned breast conserving surgery in treatment arm, Outcome 1: Overall survival
3.2
3.2. Analysis
Comparison 3: Downstaged vs planned breast conserving surgery in treatment arm, Outcome 2: Loco‐regional recurrence
4.1
4.1. Analysis
Comparison 4: Preoperative vs postoperative chemotherapy (Subgroup Local treatment), Outcome 1: Loco‐regional recurrence
5.1
5.1. Analysis
Comparison 5: Preoperative vs postoperative chemotherapy (Subgroup Treatment arm), Outcome 1: Loco‐regional treatment (mastectomy rate)
6.1
6.1. Analysis
Comparison 6: Preoperative vs postoperative chemotherapy (Subgroup Chemotherapy regimens), Outcome 1: Loco‐regional treatment (mastectomy rate)
7.1
7.1. Analysis
Comparison 7: Preoperative vs postoperative chemotherapy (Subgroup Methodological quality), Outcome 1: Loco‐regional treatment (mastectomy rate)
8.1
8.1. Analysis
Comparison 8: Preoperative versus postoperative chemotherapy (Excluding outlying studies), Outcome 1: Time to loco regional recurrence
8.2
8.2. Analysis
Comparison 8: Preoperative versus postoperative chemotherapy (Excluding outlying studies), Outcome 2: Loco‐regional treatment (mastectomy rate)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

ABCSG 2001 {published data only}
    1. Jakesz R. Comparison of pre- vs. postoperative chemotherapy in breast cancer patients: Four-year results of Austrian breast & colorectal cancer study group (ABCSG) trial 7. In: American Society of Clinical Oncology. Annual Meeting. 2001:Abstract 125.
Bordeaux 1991 {published data only}
    1. Mauriac L, Durand M, Avril A, Dilhuydy JM. Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm. Results of a randomized trial in a single centre. Annals of Oncology 1991;2(5):347-54. - PubMed
    1. Mauriac L, MacGrogan G, Avril A, Durand M, Floquet A, Debled M et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS). Annals of Oncology 1999;10(1):47-52. - PubMed
ECTO 2005 {published data only}
    1. Eiermann W, Sabadell D, Baselga J, Vazquez V, Guillem Porta V, Semiglazov V et al. European cooperative trial in operable breast cancer (ECTO): No increased risk of local breast tumor recurrence (LBR) as first and only event after primary systemic therapy (PST). In: American Society of Clinical Oncology. Vol. 22. 2003:Abstract 37.
    1. Gianni L, Baselga J, Eiermann W, Guillem Porta V, Semiglazov V, Lluch A et al. European cooperative trial in operable breast cancer (ECTO): Improved freedom from progression (FFP) from adding paclitaxel (T) to doxorubicin (A) followed by cyclophosphamide methotrexate and fluorouracil (CMF). Journal of Clinical Oncology, ASCO Annual Meeting Proceedings 2005;23(Suppl 16):Abstract 513.
Edinburgh 1995 {published data only}
    1. Forouhi P, Dixon JM, Leonard RC, Chetty U. Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer. British Journal of Surgery 1995;82(1):79-82. - PubMed
EORTC 2001 {published and unpublished data}
    1. Hage JA, de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. Journal of Clinical Oncology 2001;19(22):4224-37. - PubMed
Institut Curie 1991 {published data only}
    1. Scholl SM, Asselain B, Palangie T, Dorval T, Jouve M, Garcia Giral E et al. Neoadjuvant chemotherapy in operable breast cancer. European Journal of Cancer 1991;27(12):1668-71. - PubMed
Institut Curie 1994 {published data only}
    1. Broet P, Scholl SM, la Rochefordiere A, Fourquet A, Moreau T, De Rycke Y et al. Short and long-term effects on survival in breast cancer patients treated by primary chemotherapy: an updated analysis of a randomized trial. Breast Cancer Res Treat 1999;58(2):151-56. - PubMed
    1. Scholl SM, Fourquet A, Asselain B, Pierga JY, Vilcoq JR, Durand JC et al. Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6. European Journal of Cancer 1994;30A(5):645-52. - PubMed
    1. Scholl SM, Pierga JY, Asselain B, Beuzeboc P, Dorval T, Garcia-Giralt E et al. Breast tumour response to primary chemotherapy predicts local and distant control as well as survival. European Journal of Cancer 1995;31A(12):1969-75. - PubMed
Japan 1998 {published and unpublished data}
    1. Enomoto K, Ikeda T, Matsui A, Kitajima M, Koh J, Masamura S et al. Neoadjuvant therapy in stage II with T>=4CM and stage III breast cancer. In: 6th International Conference Adjuvant therapy for Primary Breast Cancer St Gallen. 1998:P73.
Lithuania 1998 {published data only}
    1. Ostapenko V, Pipiriene T, Valuckas K. Primary chemotherapy in conservative treatment of stage II breast cancer. In: In 6th International Conference Adjuvant therapy for Primary Breast Cancer St Gallen. 1998:Abstract P78.
London 2001 {published data only}
    1. Gazet JC, Ford HT, Gray R, McConkey C, Sutcliffe R, Quilliam J et al. Estrogen-receptor-directed neoadjuvant therapy for breast cancer: results of a randomised trial using formestane and methotrexate, mitozantrone and mitomycin C (MMM) chemotherapy. Annals of Oncology 2001;12(5):685-91. - PubMed
NSABP 1998 {published data only}
    1. Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. Journal of Clinical Oncology 1998;16(8):2672-85. - PubMed
    1. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18.. Journal of the National Cancer Institute. Monographs 2001;30:96-102. - PubMed
Royal Marsden 1998 {published data only}
    1. Cleator SJ, Makris A, Ashley SE, Lal R, Powles TJ. Good clinical response of breast cancers to adjuvant chemoendocrine therapy is associated with improved overall survival. Annals of Oncology 2005;16:267-72. - PubMed
    1. Makris A, Powles TJ, Ashley SE, Chang J, Hickish T, Tidy VA, Nash AG, Ford HT. A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer. Annals of Oncology 1998;9(11):1179-84. - PubMed
St. Petersburg 1994 {published data only}
    1. Semiglazov VF, Topuzov EE, Bavli JL, Moiseyenko VM, Ivanova OA, Seleznev IK et al. Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb-IIIa breast cancer. Annals of Oncology 1994;5(7):591-5. - PubMed
USA 2003 {published data only}
    1. Danforth DN Jr, Cowan K, Altemus R, Merino M, Chow C, Berman A, et al. Preoperative FLAC/granulocyte-colony-stimulating factor chemotherapy for stage II breast cancer: a prospective randomized trial. Annals of Surgical Oncology 2003;10(6):635-44. - PubMed

References to studies excluded from this review

Deo 2003 {published data only}
    1. Deo SV, Bhutani M, Shukla NK, Raina V, Rath GK, Purkayasth J. Randomized trial comparing neo-adjuvant versus adjuvant chemotherapy in operable locally advanced breast cancer (T4b N0-2 M0). Journal of Surgical Oncology 2003;84(4):192-7. - PubMed
Hyams 1993 {published data only}
    1. Hyams DM, Fieler MA, Nobis G. An institutional experience with preoperative systematic chemotherapy in early stage breast cancer. Breast Cancer Research & Treatment 1993;27(1/2):147 (Abstract 68).
Ragaz 1997 {published data only}
    1. Ragaz J, Baird R, Rebbeck P, Trevisan C, Goldie J, Coldman A. Preoperative (neoadjuvant - PRE) versus postoperative (POST) adjuvant chemotherapy (CT) for stage i-II breast cacner (SI-II BC). Long-term analysis of British Columbia randomized trial. In: American Society of Clinical Oncology. Annual Meeting. 1997:Abstract 499.
Shao 1999 {published data only}
    1. Shao ZM, Li J, Wu J, Han QX, Shen ZZ, Fontana JA et al. Neo-adjuvant chemotherapy for operable breast cancer induces apoptosis. Breast Cancer Research and Treatment 1999;53(3):263-9. - PubMed
Stauffer 1993 {published data only}
    1. Stauffer JS, Allred DC, Aust JB, Cruz AB. Preoperative versus postoperative adjuvant chemotherapy in early operable breast cancer. Breast Cancer Research & Treatment 1993;27(1/2):148 (Abstract 148).

Additional references

Abraham 1996
    1. Abraham DC, Jones RC, Jones SE, Cheek JH, Peters GN, Knox SM et al. Evaluation of neoadjuvant chemotherapeutic response of locally advanced breast cancer by magnetic resonance imaging. Cancer 1996;78(1):91-100. - PubMed
Arriagada 2003
    1. Arriagada R, Le MG, Guinebretiere JM, Dunant A, Rochard F, Tursz T. Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Annals Of Oncology 2003;14(11):1617-22. [MEDLINE: ] - PubMed
Ayers 2004
    1. Ayers M, Symmans WF, Stec J, Damokosh AI, Clark E, Hess K et al. Gene expression profiles predict complete pathologic response to neoadjuvant paclitaxel and fluorouracil, doxorubicin, and cyclophosphamide chemotherapy in breast cancer. J Clin Oncol 2004;22(12):2284-93. - PubMed
Bear 2006
    1. Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer:National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2006;24(13):2019-27. - PubMed
Blichert‐Toft 1992
    1. Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. Journal National Cancer Institute Monographs 1992;11:19-25. - PubMed
Bonadonna 1990
    1. Bonadonna G, Veronesi U, Brambilla C, Ferrari L, Luini A, Greco M, et al. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. Journal of the National Cancer Institute 1990;82(19):1539-45. - PubMed
Bonadonna 1995
    1. Bonadonna G, Valagussa P, Moliterni A, Zambetti M, Brambilla C. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: The results of 20 years of follow-up. New England Journal of Medicine 1995;332:901-6. - PubMed
Buzdar 2005
    1. Buzdar AU, Ibrahim NK, Francis D, Booser DJ, Thomas ES, Theriault RL et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. Journal of Clinical Oncology 2005;23(16):3676-85. - PubMed
Chang 2003
    1. Chang JC, Wooten EC, Tsimelzon A, Hilsenbeck SG, Gutierrez MC, Elledge R et al. Gene expression profiling for the prediction of therapeutic response to docetaxel in patients with breast cancer. Lancet 2003;362(9381):362-9. - PubMed
Chua 2005
    1. Chua S, Smith IE, A'Hern RP, Coombes GA, Hickish TF, Robinson AC et al. Neoadjuvant vinorelbine/epirubicin (VE) versus standard adriamycin/cyclophosphamide (AC) in operable breast cancer: analysis of response and tolerability in a randomised phase III trial (TOPIC 2). Annals of Oncology 2005;16(9):1435-41. - PubMed
Clarke 2005
    1. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;366(9503):2087-2106. - PubMed
Deeks 2001
    1. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG, editors(s). Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd edition. London: BMJ Publication Group, 2001.
EBCTCG 2005
    1. Early Breast Cancer Trialists' Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365(9472):1687-1717. - PubMed
Egger 1997
    1. Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629-34. [MEDLINE: ] - PMC - PubMed
Elkhuizen 1998
    1. Elkhuizen PH, de Vijver MJ, Hermans J, Zonderland HM, de Velde CJ, Leer JW. Local recurrence after breast-conserving therapy for invasive breast cancer: high incidence in young patients and association with poor survival. International Journal of Radiation Oncology Biology Physics 1998;40(4):859-67. [MEDLINE: ] - PubMed
Evans 2005
    1. Evans TR, Yellowlees A, Foster E, Earl H, Cameron DA, Hutcheon AW et al. Phase III randomized trial of doxorubicin and docetaxel versus doxorubicin and cyclophosphamide as primary medical therapy in women with breast cancer: an anglo-celtic cooperative oncology group study. Journal of Clinical Oncology 2005;23(13):2988-2995. - PubMed
Felici 2005
    1. Felici A, Bria E, Ferretti G, Carlini P, Ciccarese M, Cecere FL, et al. Taxanes as neoadjuvant chemotherapy for breast cancer: Pooled-analysis of 3120 patients enrolled in 10 randomized trials. J Clin Oncol ASCO Annual Meeting Proceedings 2005;16S:682.
Ferlay 2001
    1. Ferlay J, Bray F, Pisani P, Parkin DM. Cancer Incidence, Mortality and Prevalence Worldwide. GLOBOCAN, Version 1.0. IARC CancerBase No. 5. Lyon, IARCPress, 2001.
Fisher 1989
    1. Fisher B, Redmond C, Dimitrov NV, Bowman D, Legault-Poisson S, Wickerham DL, et al. A randomized clinical trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen-receptor-negative tumors. New England Journal of Medicine 1989;320:473-8. - PubMed
Fisher 1995
    1. Fisher B, Mamounas EP. Preoperative chemotherapy: a model for studying the biology and therapy of primary breast cancer. J Clin Oncol 1995;13(3):537-540. - PubMed
Fisher 2002
    1. Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. The New England Journal Of Medicine 2002;347(8):567-575. - PubMed
Fredriksson 2002
    1. Fredriksson I, Liljegren G, Arnesson L-G, Emdin SO, Palm-Sjovall M, Fornander T et al. Local recurrence in the breast after conservative surgery--a study of prognosis and prognostic factors in 391 women. European Journal of Cancer 2002;38(14):1860-1870. - PubMed
Fredriksson 2003
    1. Fredriksson I, Liljegren G, Palm-Sjovall M, Arnesson LG, Emdin SO, Fornander T et al. Risk factors for local recurrence after breast-conserving surgery. Br J Surg 2003;90(9):1093-1102. - PubMed
Goodwin 2003
    1. Goodwin PJ, Black JT, Bordeleau LJ, Ganz PA. Health-related quality-of-life measurement in randomized clinical trials in breast cancer--taking stock. JNCI Cancer Spectrum 2003;95(4):263-281. [MEDLINE: ] - PubMed
Haagensen 1943a
    1. Haagensen CD, Stout AP. Carcinoma of the breast. Criteria of inoperability. The American surgeon 1943;118:859-66.
Haagensen 1943b
    1. Haagensen CD, Stout AP. Carcinoma of the breast. Criteria of inoperability. The American surgeon 1943;118:1032-40.
Hannemann 2005
    1. Hannemann J, Oosterkamp HM, Bosch CA, Velds A, Wessels LF, Loo C et al. Changes in gene expression associated with response to neoadjuvant chemotherapy in breast cancer. J Clin Oncol 2005;23(15):3331-3342. - PubMed
Hayward 1977
    1. Hayward JL, Carbone PP, Heuson JC, Kumaoka S, Segaloff A, Rubens RD. Assessment of response to therapy in advanced breast cancer: a project of the Programme on Clinical Oncology of the International Union Against Cancer, Geneva, Switzerland. Cancer 1977;39(3):1289-1294. - PubMed
Higgins 2002
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-1558. - PubMed
Hortobagyi 1983
    1. Hortobagyi GN, Blumenschein GR, Spanos W, Montague ED, Buzdar AU, Yap HY, et al. Multimodal treatment of locoregionally advanced breast cancer. Cancer 1983;51(5):763-8. - PubMed
Hortobagyi 1988
    1. Hortobagyi GN, Ames FC, Buzdar AU, Kau SW, McNeese MD, Paulus D, et al. Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy. Cancer 1988;62(12):2507-16. - PubMed
Hortobagyi 1997
    1. Hortobagyi GN, Buzdar AU. Locally advanced breast cancer. In: Bonadonna G, Hortobagyi GN, Gianni AM, editors(s). Textbook of Breast Cancer: A Clinical Guide to Therapy. London, UK: Martin Dunitz Ltd, 1997:155-68.
Jacquillat 1989
    1. Jacquillat C, Weil M, Auclerc G, Auclerc MF, Khayat D, Baillet F. Neoadjuvant chemotherapy in the conservative management of breast cancer: a study of 252 patients. Recent Results in Cancer Research 1989;115:36-42. - PubMed
Kaufmann 2003
    1. Kaufmann M, Minckwitz G, Smith R, Valero V, Gianni L, Eiermann W, et al. International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendations. Journal of Clinical Oncology 2003;21(13):2600-8. - PubMed
Kiebert 1991
    1. Kiebert GM, Haes JC, de Velde CJ. The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review. J Clin Oncol 1991;9(6):1059-1070. - PubMed
Mansour 1998
    1. Mansour EG, Gray R, Shatila AH, Tormey DC, Cooper MR, Osborne CK, et al. Survival advantage of adjuvant chemotherapy in high-risk node-negative breast cancer: Ten-year analysis--an intergroup study. Journal of Clinical Oncology 1998;16:3486-92. - PubMed
Molenaar 2004
    1. Molenaar S, Oort F, Sprangers M, Rutgers E, Luiten E, Mulder J et al. Predictors of patients' choices for breast-conserving therapy or mastectomy: a prospective study. Br J Cancer 2004;90(11):2123-2130. - PMC - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815-34. - PubMed
Pavic 2004
    1. Pavic D, Koomen MA, Kuzmiak CM, Lee YH, Pisano ED. The role of magnetic resonance imaging in diagnosis and management of breast cancer. Technol Cancer Res Treat 2004;3(6):527-541. - PubMed
Perloff 1982
    1. Perloff M, Lesnick GJ. Chemotherapy before and after mastectomy in stage III breast cancer. Archives of surgery 1982;117:879-81. - PubMed
Poggi 2003
    1. Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer 2003;98(4):697-702. - PubMed
Schick 1983
    1. Schick P, Goodstein J, Moor J, Butler J, Senter KL. Preoperative chemotherapy followed by mastectomy for locally advanced breast cancer. Journal of Surgical Oncology 1983;22(4):278-82. - PubMed
Segel 1988
    1. Segel MC, Paulus DD, Hortobagyi GN. Advanced primary breast cancer: assessment at mammography of response to induction chemotherapy. Radiology 1988;169(1):49-54. - PubMed
Sharkey 1996
    1. Sharkey FE, Addington SL, Fowler LJ, Page CP, Cruz AB. Effects of preoperative chemotherapy on the morphology of resectable breast carcinoma. Mod Pathol 1996;9(9):893-900. - PubMed
Smith 2005
    1. Smith IE, Dowsett M, Ebbs SR, Dixon JM, Skene A, Blohmer JU et al. Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial. J Clin Oncol 2005;23(22):5108-5116. - PubMed
Therasse 2000
    1. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205-216. - PubMed
van der Hage 2003
    1. Hage JA, Putter H, Bonnema J, Bartelink H, Therasse P, de Velde CJ, EORTC Breast Cancer Group. Impact of locoregional treatment on the early-stage breast cancer patients: a retrospective analysis. Eur J Cancer 2003;39(15):2192-2199. - PubMed
van Dongen 2000
    1. Dongen JA. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European organization for research and treatment of cancer 10801 trial. J Natl Cancer Inst 2000;92(14):1143-1150. - PubMed
van Tienhoven 1999
    1. Tienhoven G, Voogd AC, Peterse JL, Nielsen M, Andersen KW, Mignolet et al. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 1999;35(1):32-38. - PubMed
Veronesi 1995
    1. Veronesi U, Bonadonna G, Zurrida S, Galimberti V, Greco M, Brambilla C et al. Conservation surgery after primary chemotherapy in large carcinomas of the breast. Ann Surg 1995;222(5):612-618. - PMC - PubMed
Veronesi 2002
    1. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine 2002;347(16):1227-1232. - PubMed
Vinnicombe 1996
    1. Vinnicombe SJ, MacVicar AD, Guy RL, Sloane JP, Powles TJ, Knee G et al. Primary breast cancer: mammographic changes after neoadjuvant chemotherapy, with pathologic correlation. Radiology 1996;198(2):333-340. - PubMed
Voogd 2005
    1. Voogd AC, Oost FJ, Rutgers EJT, Elkhuizen PHM, Geel AN, Scheijmans LJEE et al. Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer. European Journal of Cancer 2005;41(17):2637-2644. - PubMed
Wang 2005
    1. Wang Y, Klijn JG, Zhang Y, Sieuwerts AM, Look MP, Yang F et al. Gene-expression profiles to predict distant metastasis of lymph-node-negative primary breast cancer. Lancet 2005;365(9460):671-679. - PubMed
Whelan 2000
    1. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. Journal of Clinical Oncology 2000;18(6):1220-1229. - PubMed
Wolff 2000
    1. Wolff AC, Davidson NE. Primary systemic therapy in operable breast cancer. J Clin Oncol 2000;18(7):1558-1569. - PubMed
Xing 2006
    1. Xing Y, Foy M, Cox DD, Kuerer HM, Hunt KK, Cormier JN. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg 2006;93(5):539-546. - PubMed
Yusuf 1985
    1. Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Progress in Cardiovascular Diseases 1985;27:335-371. - PubMed

Substances