Preoperative Paclitaxel and Radiotherapy for Locally Advanced Breast Cancer: Surgical Aspects

Abstract

Preoperative paclitaxel with radiotherapy is well tolerated and provides significant pathological response, in up to 33% of patients with locally advanced breast cancer, but with a significant postoperative morbidity rate.

Preoperative Twice-Weekly Paclitaxel With Concurrent Radiation Therapy Followed by Surgery and Postoperative Doxorubicin-Based Chemotherapy in Locally Advanced Breast Cancer: A Phase I/II Trial

“…Chemoradiation toxicity was mainly dermatitis within the RT field, similar to what was reported by Bellon et al 2 Several important differences, however, exist between their retrospective series and the current prospective study. 21 It is reassuring to note that tolerance to postoperative AT or AC was very good; grade 4 leukopenia was observed in 10% of patients, and no other grade 4 toxicity was observed. Moreover, their total dose (50 to 54 Gy compared with 45 Gy in the current study) and technique of RT (use of bolus in 60% of patients) may explain the fact that in 38% of patients, breaks were required during the course of RT therapy, with a median duration of 8 days.…”

Neoadjuvante interstitielle HDR-Brachytherapie in Kombination mit Chemotherapie bei Patientinnen mit Mammakarzinom

“…A study published in 1999 by the same authors showed an increased pCR rate of 26% after neoadjuvant treatment with paclitaxel and EBRT of the whole breast up to 45 Gy [40]. In the study by Aryus et al comparing combined neoadjuvant radiochemotherapy to chemotherapy alone, the authors were able to show a significant difference between the two groups: patients treated with radiochemotherapy had a pCR rate of 43%, compared to only 6% of patients in the chemotherapy group.…”

“…In studies using neoadjuvant combined radiochemotherapy, rates of histopathologic complete remission ranged from 8.6% to 43% [2,8,15,[38][39][40].…”

“…Only few studies investigated the combination of chemotherapy and radiotherapy in the neoadjuvant setting [2,8,15,[38][39][40]. Interestingly, Gerlach et al were able to show significantly higher rates of pCR after radiochemotherapy compared to chemotherapy alone [15].…”

New treatment sequence protocol to reconstruct locally advanced breast cancer

“…Skinner studied paclitaxel based neoadjuvant chemotherapy and radiotherapy as primary treatment in 29 patients, 27 of whom went on to either BCS or modified radical mastectomy . While clinical responses occurred in 89% and 33% had significant pathological response, surgical complications occurred in 41% in all types of surgery.…”