Timing of Chemotherapy

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Timing of Chemotherapy

Posted 9/26/2011

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It is sometimes suggested that a woman have chemotherapy (then called neoadjuvant chemotherapy) prior to surgery rather than the more usual schedule that puts surgery first. A recent study suggests that the timing does not really make a difference in outcome. Instead, not surprisingly, what makes a difference is other factors of the cancer itself.

Here is BreastCancer.Org's article about it. I give you the beginning and then a link:

Cancer Characteristics Determine Outcomes After

Lumpectomy, Not Chemo Timing

(As reported in MedPage Today)

Breastcancer.org says:

Treatment given to weaken and destroy breast cancer BEFORE surgery is called neoadjuvant treatment. Neoadjuvant treatment isn't routinely used to treat early-stage breast cancer, but may be used if the cancer is large or aggressive.

One or more chemotherapy medicines usually make up a neoadjuvant regimen. The targeted therapy Herceptin (chemical name: trastzumab) and hormonal therapy sometimes also are given before surgery. Many women who receive neoadjuvant treatment get chemotherapy and other treatments after surgery, too. Treatments given after surgery are called adjuvant treatments. Adjuvant treatments are given to lower the risk of the cancer coming back(recurrence).

Some surgeons don't like to do lumpectomy (instead of mastectomy) after neoadjuvant chemotherapy. Because the neoadjuvant chemotherapy usually shrinks the breast cancer, the surgeons are concerned they won't be able to tell how much breast tissue was involved with the breast cancer and so won't know how much tissue to remove during lumpectomy. Not removing all the affected tissue can increase the risk of the cancer coming back in the breast area (loco-regional recurrence).

A study presented at the September 2011 Multidisciplinary Breast Cancer Symposium found no difference in the risk of loco-regional recurrence between women diagnosed with early-stage breast cancer who had neoadjuvant chemotherapy and then lumpectomy and women who had lumpectomy and then adjuvant chemotherapy. Instead of the timing of the chemotherapy, the characteristics of the cancer were what affected the risk of recurrence. The results suggest that lumpectomy still may be a good surgical choice for many women who will get neoadjuvant chemotherapy.