Abstract

Neo-adjuvant radiochemotherapy in breast cancer

Neaoadjuvant chemotherapy is currently offered to women with breast cancer too large to undergo breast-conserving surgery. Several randomised trials have demonstrated that neoadjuvant chemotherapy could allow a large proportion of women to preserve their breast, without impairing survival in comparison to mastectomy followed by adjuvant chemotherapy. Radiotherapy in a neoadjuvant setting has been used in the 70’s and ealy 80’s. A prospective randomised study had shown similar results between radiotherapy followed by mastectomy, or mastectomy followed by radiotherapy. Concurrent radiochemotherapy has demonstrated survival benefits in various tumor locations, such as oesophagus, anal canal, uterine cervix, lung, and head and neck. Two prospective randomised trials have shown that the concurrent delivery of radiotherapy and chemotherapy following breast-conserving surgery significantly reduced locoregional recurrence rates in patients with pN+ve tumors, in comparison with a sequential scheme. Concurrent neoadjuvant radiochemotherapy was used in the past in patients with locally advanced or inflammatory breast cancer with good clinical results in some. More recently, several phase II trials have investigated the efficacy of neoadjuvant concurrent radiotherapy and various chemotherapy combinations. This talk will present the results from Institut Curie series and review the available data in the literature. It will discuss the potential of concurrent radiochemotherapy schemes, and the interest of the use of targeted therapies with radiotherapy in breast cancer.