Neoadjuvant Chemotherapy for Breast Cancer, Is Practice Changing? A Population-Based Review of Current Surgical Trends

Abstract

A significant increase in the use of neoadjuvant chemotherapy over time was identified, and treatment with mastectomy as definitive surgical management remained high. There was significant variability in neoadjuvant chemotherapy use by the operating surgeons, in addition to factors generally associated with more locally advanced/aggressive tumors.

Neoadjuvant Systemic Therapy in Breast Cancer: Use and Trends in Radiotherapy Practice

“…The incidence of nast in British Columbia is similar to that in other reports, including the reported 3.8% use of nast in 4 large U.S. treatment centres 20 and the 8.5% use in another Canadian province 21 . Use of nast was quite a bit lower than in another American study, which reported a nast rate of 17.4% 22 .…”

“…Use of nast was quite a bit lower than in another American study, which reported a nast rate of 17.4% 22 . All of those studies demonstrated variability by stage, centre 20 , surgeon 21 , and geographic region 22 , as in our cohort, for whom use of nast varied by cancer centre-a finding showing that, despite widely published guidelines 23,24 , potential biases based on region and training can affect patient care.…”

“…We had hypothesized that use of nast would increase during the study period, as reported by others 21,22 ; however, in our cohort, use of nast was relatively stable. The difference might be explained by our shorter time period (5 years compared with the 8 years used by Mougalian et al 22 ) or by significant increases in nast use after 2012 (the period used by Graham et al 21 ).…”

“…The difference might be explained by our shorter time period (5 years compared with the 8 years used by Mougalian et al 22 ) or by significant increases in nast use after 2012 (the period used by Graham et al 21 ). Notably, use of nast increased for earlystage disease (i-ii), but stayed stable for stage iii disease.…”

Chimiothérapie néoadjuvante : pour qui ?

“…Une étude récente a évalué les changements de pratique au Canada et a montré que le taux de CNA était passé de 7,4 % en 2012 à 10,4 % en 2014 [7]. Cependant, le seul bénéfice direct démontré pour le patient est à ce jour limité à son impact sur la stratégie locorégionale, puisque les survies ne sont pas statistiquement différentes actuellement (par rapport à la chirurgie première) et qu'aucune étude n'a montré de bénéfice à changer de protocole de chimiothérapie en cas de réponse insuffisante.…”