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Review
. 2020 Apr;15(2):112-117.
doi: 10.1159/000507041. Epub 2020 Apr 14.

Neoadjuvant Radio(chemo)therapy for Breast Cancer: An Old Concept Revisited

Christiane Matuschek  1 , Carolin Nestle-Kraemling  2 , Thorsten Kühn  3 , Tanja Fehm  4 , Edwin Bölke  1 , Stefanie Corradini  5 , Gerd Fastner  6 , Kitti Maas  1 , Clemens Seidel  7 , Wilfried Budach  1
Affiliations
Review

Neoadjuvant Radio(chemo)therapy for Breast Cancer: An Old Concept Revisited

Christiane Matuschek et al. Breast Care (Basel). 2020 Apr.

Abstract

Background: The international standard of care for the treatment of high-risk breast cancer (BC) consists of neoadjuvant chemotherapy (NACT) and surgery followed by adjuvant whole breast/chest wall irradiation. In this setting, the time interval from the start of NACT to the end of radiotherapy (RT) is usually postponed to 6 months or longer. In addition to this, a high percentage of capsular fibrosis may occur when breast implants are irradiated. Most of these disadvantages could be avoided by using preoperative RT (PRT). PRT is already the standard of care in several other tumor entities (rectal cancer, esophagus carcinoma, lung cancer, and soft tissue sarcoma). Nevertheless, PRT in BC has been tested in several trials, but randomized prospective trials using modern radiation technology and systemic therapies are lacking. The available evidence summarized in this review indicates that PRT may improve survival and reduce long-term toxicity in patients with a higher risk of recurrence and should be consequently tested in a randomized trial.

Summary: Prospective, randomized trials concerning PRT in high-risk BC are needed. We plan to conduct a NeoRad trial (NACT followed by PRT in high-risk BC).

Key messages: Prospective, randomized studies concerning PRT in high-risk BC are needed.

Keywords: Breast cancer; Immediate reconstruction; Neoadjuvant chemotherapy; Preoperative radiotherapy.

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Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Study design of the NeoRad trial.
See this image and copyright information in PMC

References

    1. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005 Feb;97((3)):188–94. - PubMed
    1. Corradini S, Krug D, Meattini I, Matuschek C, Bölke E, Francolini G, et al. Preoperative radiotherapy: A paradigm shift in the treatment of breast cancer? A review of literature. Crit Rev Oncol Hematol. 2019 Sep;141:102–11. - PubMed
    1. Asselain B, Barlow W, Bartlett J, Bergh J, Bergsten-Nordström E, Bliss J, et al. Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018 Jan;19((1)):27–39. - PMC - PubMed
    1. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. German Rectal Cancer Study Group Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004 Oct;351((17)):1731–40. - PubMed
    1. O'Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002 Jun;359((9325)):2235–41. - PubMed