Surgical Issues and Preoperative Systemic Therapy

  • Lisa A. Newman
Part of the Cancer Treatment and Research book series (CTAR, volume 141)

Neoadjuvant (preoperative) chemotherapy was initially developed as a treatment strategy for patients presenting with locally advanced breast cancer, as a means of improving resectability and locoregional control. This treatment sequence has now become standard, conventional practice for patients with bulky cancers of the breast and axillae. Two important advantages identified from this experience have resulted in extension of the neoadjuvant therapy approach to include early-stage breast cancer patients as potential candidates: (i) primary disease downstaging, thereby increasing lumpectomy eligibility (ii) earlier assessment of chemosensitivity versus identification of patients with resistant disease, thereby providing opportunities to individualize therapy

Furthermore, several studies have documented the finding that response in the breast correlates with survival, thereby demonstrating that primary tumor downstaging is an excellent surrogate marker for systemic therapy effectiveness. Many breast cancer patients will benefit from systemic therapy to control occult micrometastases in distant organs. As insights broaden regarding the heterogeneity of tumor biology, and as we learn more about treatment toxicity, it has become abundantly clear that expansion of the systemic therapy armamentarium is warranted. Assessment of novel therapies in the prospective adjuvant randomized clinical trial setting typically requires several thousand patient-years of follow-up, and these studies are extremely costly. Ability to evaluate new regimens in the neoadjuvant setting offers the promise of determining chemoeffectiveness within a few months, by using pathologic extent of tumor response from surgery as a surrogate for results achieved in distant organs.

Neoadjuvant chemotherapy has therefore become an advantageous treatment sequence for many reasons, and may be considered for application in any breast cancer case where the multidisciplinary oncology team is confident that chemotherapy is a necessary component of the patient’s comprehensive therapy. The decision to proceed with neoadjuvant chemotherapy is accompanied by several special considerations that must be handled by the surgeon, and these considerations involve the pre-treatment/diagnostic phase as well as local and regional management.


Breast Cancer Clin Oncol Sentinel Lymph Node Biopsy Preoperative Chemotherapy Breast Reconstruction 


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  1. 1.
    Smith, S. D., Z. Cason, D. E. Cabaniss, H. A. Benghuzzi, L. B. Lemos. 1997. Accuracy of fine needle aspiration biopsy of the breast. Biomed Sci Instrum 33:286–91.PubMedGoogle Scholar
  2. 2.
    Rody, A., T. Karn, R. Gatje, K. Kourtis, G. Minckwitz, S. Loibl, et al. 2006. Gene expression profiles of breast cancer obtained from core cut biopsies before neoadjuvant docetaxel, adriamycin, and cyclophoshamide chemotherapy correlate with routine prognostic markers and could be used to identify predictive signatures. Zentralbl Gynakol 128:76–81.PubMedCrossRefGoogle Scholar
  3. 3.
    Park, S., C. Shimizu, T. Shimoyama, M. Takeda, M. Ando, T. Kohno, et al. 2006. Gene expression profiling of ATP-binding cassette (ABC) transporters as a predictor of the pathologic response to neoadjuvant chemotherapy in breast cancer patients. Breast Cancer Res Treat 99:9–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Pusztai, L., M. Ayers, J. Stec, G. N. Hortobagyi. 2003. Clinical application of cDNA microarrays in oncology. Oncologist 8:252–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Sato, K., K. Tamaki, H. Tsuda, S. Kosuda, S. Kusano, H. Hiraide, et al. 2004. Utility of axillary ultrasound examination to select breast cancer patients suited for optimal sentinel node biopsy. Am J Surg 187:679–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Bedrosian, I., D. Bedi, H. M. Kuerer, B. D. Fornage, L. Harker, M. I. Ross, et al. 2003. Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol 10:1025–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Khan, A., M. S. Sabel, A. Nees, K. M. Diehl, V. M. Cimmino, C. G. Kleer, et al. 2005. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy. Ann Surg Oncol 12:697–704.PubMedCrossRefGoogle Scholar
  8. 8.
    Bristol, I. J., T. A. Buchholz. 2005. Inflammatory breast cancer: current concepts in local management. Breast Dis 22:75–83.PubMedGoogle Scholar
  9. 9.
    Newman, L. A., A. U. Buzdar, S. E. Singletary, H. M. Kuerer, T. Buchholz, F. C. Ames, et al. 2002. A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility. Ann Surg Oncol 9:228–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Broadwater, J. R., M. J. Edwards, C. Kuglen, G. N. Hortobagyi, F. C. Ames, C. M. Balch. 1991. Mastectomy following preoperative chemotherapy. Strict operative criteria control operative morbidity. Ann Surg 213:126–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Danforth, D. N., Jr., M. E. Lippman, H. McDonald, J. Bader, E. Egan, M. Lampert, et al. 1990. Effect of preoperative chemotherapy on mastectomy for locally advanced breast cancer. Am Surg 56:6–11.PubMedGoogle Scholar
  12. 12.
    Singletary, S. E., M. D. McNeese, G. N. 1992. Hortobagyi. Feasibility of breast-conservation surgery after induction chemotherapy for locally advanced breast carcinoma. Cancer 69:2849–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Fisher, B., H. Rockette, A. Robidoux, et al. 1994. Effect of preoperative therapy for breast cancer (BC) on local-regional disease: First report of NSABP B-18. Proc Am Soc Clin Oncol 13:64, abstract 57.Google Scholar
  14. 14.
    Fisher, B., A. Brown, E. Mamounas, S. Wieand, A. Robidoux, R. G. Margolese, et al. 1997. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–93.PubMedGoogle Scholar
  15. 15.
    Fisher, B., J. Bryant, N. Wolmark, E. Mamounas, A. Brown, E. R. Fisher, et al. 1998. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16:2672–85.PubMedGoogle Scholar
  16. 16.
    Wolmark, N., J. Wang, E. Mamounas, J. Bryant, B. Fisher. 2001. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 96–102.Google Scholar
  17. 17.
    Heys, S. D., A. W. Hutcheon, T. K. Sarkar, K. N. Ogston, I. D. Miller, S. Payne, et al. 2002. Neoadjuvant docetaxel in breast cancer: 3-year survival results from the Aberdeen trial. Clin Breast Cancer 3 Suppl 2:S69–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Smith, I. C., S. D. Heys, A. W. Hutcheon, I. D. Miller, S. Payne, F. J. Gilbert, et al. 2002. Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol 20:1456–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Helvie, M. A., L. K. Joynt, R. L. Cody, L. J. Pierce, D. D. Adler, S. D. Merajver. 1996. Locally advanced breast carcinoma: accuracy of mammography versus clinical examination in the prediction of residual disease after chemotherapy. Radiology 198:327–32.PubMedGoogle Scholar
  20. 20.
    Balu-Maestro, C., C. Chapellier, A. Bleuse, I. Chanalet, C. Chauvel, R. Largillier. 2002. Imaging in evaluation of response to neoadjuvant breast cancer treatment benefits of MRI. Breast Cancer Res Treat 72:145–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Nakamura, S., H. Kenjo, T. Nishio, T. Kazama, O. Do, K. Suzuki. 2001. 3D-MR mammography-guided breast conserving surgery after neoadjuvant chemotherapy: clinical results and future perspectives with reference to FDG-PET. Breast Cancer 8:351–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Schott, A. F., M. A. Roubidoux, M. A. Helvie, D. F. Hayes, C. G. Kleer, L. A. Newman, et al. 2005. Clinical and radiologic assessments to predict breast cancer pathologic complete response to neoadjuvant chemotherapy. Breast Cancer Res Treat 92:231–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Nakamura, S., M. Ishiyama, H. Tsunoda-Shimizu. 2007. Magnetic Resonance Mammography has Limited Ability to Estimate Pathological Complete Remission after Primary Chemotherapy or Radiofrequency Ablation Therapy. Breast Cancer 14:123–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Newman, L. A. , H. M. Kuerer. 2005. Advances in breast conservation therapy. J Clin Oncol 23:1685–97.PubMedCrossRefGoogle Scholar
  25. 25.
    Newman, L. A., T. A. Washington. 2003. New trends in breast conservation therapy. Surg Clin North Am 83:841–83.PubMedCrossRefGoogle Scholar
  26. 26.
    Cristofanilli, M., A. Gonzalez-Angulo, N. Sneige, S. W. Kau, K. Broglio, R. L. Theriault, et al. 2005. Invasive lobular carcinoma classic type: response to primary chemotherapy and survival outcomes. J Clin Oncol 23:41–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Mathieu, M. C., R. Rouzier, A. Llombart-Cussac, L. Sideris, S. Koscielny, J. P. Travagli, et al. 2004. The poor responsiveness of infiltrating lobular breast carcinomas to neoadjuvant chemotherapy can be explained by their biological profile. Eur J Cancer 40:342–51.PubMedCrossRefGoogle Scholar
  28. 28.
    Kuerer, H. M., L. A. Newman, T. L. Smith, F. C. Ames, K. K. Hunt, K. Dhingra, et al. 1999. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17:460–9.PubMedGoogle Scholar
  29. 29.
    Chen, A. M., F. Meric-Bernstam, K. K. Hunt, H. D. Thames, E. D. Outlaw, E. A. Strom, et al. 2005. Breast conservation after neoadjuvant chemotherapy. Cancer 103:689–95.PubMedCrossRefGoogle Scholar
  30. 30.
    Newman, L. A., H. M. Kuerer, K. K. Hunt, F. C. Ames, M. I. Ross, R. Theriault, et al. 1999. Feasibility of immediate breast reconstruction for locally advanced breast cancer. Ann Surg Oncol 6:671–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Styblo, T., M. Lewis, G. Carlson, D. Murray, W. Wood, I. Lawson, et al. 1996. Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculotaneous (TRAM) flap. Annals of Surgical Oncology 3:375–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Tran, N. V., D. W. Chang, A. Gupta, S. S. Kroll, G. L. Robb. 2001. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg 108:78–82.PubMedCrossRefGoogle Scholar
  33. 33.
    Recht, A., S. B. Edge, L. J. Solin, D. S. Robinson, A. Estabrook, R. E. Fine, et al. 2001. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1539–69.PubMedGoogle Scholar
  34. 34.
    Mamounas E., J. Wang, J. Bryant, B. Fisher, D. L. Wickerham, N. Wolmark. Patterns of loco-regional failure in patients receiving neoadjuvant chemotherapy: Results from NSABP B-18. 26th Annual San Antonio Breast Cancer Symposium. San Antonio, Texas; 2003.Google Scholar
  35. 35.
    Buchholz, T. A., A. Katz, E. A. Strom, M. D. McNeese, G. H. Perkins, G. N. Hortobagyi, et al. 2002. Pathologic tumor size and lymph node status predict for different rates of locoregional recurrence after mastectomy for breast cancer patients treated with neoadjuvant versus adjuvant chemotherapy. Int J Radiat Oncol Biol Phys 53:880–8.PubMedGoogle Scholar
  36. 36.
    Kronowitz, S. J., K. K. Hunt, H. M. Kuerer, G. Babiera, M. D. McNeese, T. A. Buchholz, et al. 2004. Delayed-immediate breast reconstruction. Plast Reconstr Surg 113:1617–28.PubMedCrossRefGoogle Scholar
  37. 37.
    Lyman, G. H., A. E. Giuliano, M. R. Somerfield, A. B. Benson, 3rd, D. C. Bodurka, H. J. Burstein, et al. 2005. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–20.PubMedCrossRefGoogle Scholar
  38. 38.
    Krishnamurthy, S., N. Sneige, D. G. Bedi, B. S. Edieken, B. D. Fornage, H. M. Kuerer, et al. 2002. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 95:982–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Sabel, M. S., A. F. Schott, C. G. Kleer, S. Merajver, V. M. Cimmino, K. M. Diehl, et al. 2003. Sentinel node biopsy prior to neoadjuvant chemotherapy. Am J Surg 186:102–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Schrenk, P., G. Hochreiner, M. Fridrik, W. Wayand. 2003. Sentinel node biopsy performed before preoperative chemotherapy for axillary lymph node staging in breast cancer. Breast J 9:282–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Ollila, D., H. Neuman, E. Dees, C. Sartor, R. Metzger, L. Carey. Lymphatic mapping and sentinel lymphadenectomy prior to neoadjuvant chemotherapy in locally advanced breast cancer patients. 26th Annual San Antonio Breast Cancer Symposium. San Antonio, TX; 2003.Google Scholar
  42. 42.
    Zirngibl, C., D. Steinfeld-Birg, H. Vogt, T. Wagner, A. Wischnik. Sentinel lymph node biopsy before neoadjuvant chemotherapy- conservation of breast and axilla, abstract #516. San Antonio Breast Cancer Symposium December 13, 2002. San Antonio, Texas; 2002.Google Scholar
  43. 43.
    Kuerer, H. M., L. A. Newman. 2005. Lymphatic mapping and sentinel lymph node biopsy for breast cancer: developments and resolving controversies. J Clin Oncol 23:1698–705.PubMedCrossRefGoogle Scholar
  44. 44.
    Neuman, H., L. A. Carey, D. W. Ollila, C. Livasy, B. F. Calvo, A. A. Meyer, et al. 2006. Axillary lymph node count is lower after neoadjuvant chemotherapy. Am J Surg 191:827–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Breslin, T. M., L. Cohen, A. Sahin, J. B. Fleming, H. M. Kuerer, L. A. Newman, et al. 2000. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol 18:3480–6.PubMedGoogle Scholar
  46. 46.
    Nason, K. S., B. O. Anderson, D. R. Byrd, L. K. Dunnwald, J. F. Eary, D. A. Mankoff, et al. 2000. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 89:2187–94.PubMedCrossRefGoogle Scholar
  47. 47.
    Schwartz, G. F., C. A. Birchansky, L. T. Komarnicky, C. M. Mansfield, R. I. Cantor, W. A. Biermann, et al. 1994. Induction chemotherapy followed by breast conservation for locally advanced carcinoma of the breast. Cancer 73:362–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Fernandez, A., M. Cortes, E. Benito, D. Azpeitia, L. Prieto, A. Moreno, et al. 2001. Gamma probe sentinel node localization and biopsy in breast cancer patients treated with a neoadjuvant chemotherapy scheme. Nucl Med Commun 22:361–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Julian, T. B., D. Dusi, N. Wolmark. 2002. Sentinel node biopsy after neoadjuvant chemotherapy for breast cancer. Am J Surg 184:315–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Haid, A., C. Tausch, A. Lang, J. Lutz, H. Fritzsche, W. Peschina, et al. 2001. Is sentinel lymph node biopsy reliable and indicated after preoperative chemotherapy in patients with breast carcinoma? Cancer 92:1080–4.PubMedCrossRefGoogle Scholar
  51. 51.
    Reitsamer, R., F. Peintinger, L. Rettenbacher, E. Prokop. 2003. Sentinel lymph node biopsy in breast cancer patients after neoadjuvant chemotherapy. J Surg Oncol 84:63–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Aihara, T., S. Munakata, H. Morino, Y. Takatsuka. 2004. Feasibility of sentinel node biopsy for breast cancer after neoadjuvant endocrine therapy: a pilot study. J Surg Oncol 85:77–81.PubMedCrossRefGoogle Scholar
  53. 53.
    Kinoshita, T., M. Takasugi, E. Iwamoto, S. Akashi-Tanaka, T. Fukutomi, S. Terui. 2006. Sentinel lymph node biopsy examination for breast cancer patients with clinically negative axillary lymph nodes after neoadjuvant chemotherapy. Am J Surg 191:225–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Miller, A. R., V. E. Thomason, I. T. Yeh, A. Alrahwan, F. E. Sharkey, J. Stauffer, et al. 2002. Analysis of sentinel lymph node mapping with immediate pathologic review in patients receiving preoperative chemotherapy for breast carcinoma. Ann Surg Oncol 9:243–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Tafra, L., K. Verbanac, D. Lannin. 2001. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer. Am J Surg 182:312–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Balch, G. C., S. K. Mithani, K. R. Richards, R. D. Beauchamp, M. C. Kelley. 2003. Lymphatic mapping and sentinel lymphadenectomy after preoperative therapy for stage II and III breast cancer. Ann Surg Oncol 10:616–21.PubMedCrossRefGoogle Scholar
  57. 57.
    Brady, E. 2002. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer. Breast J 8:97–100.PubMedCrossRefGoogle Scholar
  58. 58.
    Piato, J., A. Barros, K. Pincerato, A. Sampaio, J. Pinotti. 2002. Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study. Eur J Surg Oncol 29:118–20.CrossRefGoogle Scholar
  59. 59.
    Shimazu, K., Y. Tamaki, T. Taguchi, K. Akazawa, T. Inoue, S. Noguchi. 2004. Sentinel lymph node biopsy using periareolar injection of radiocolloid for patients with neoadjuvant chemotherapy-treated breast carcinoma. Cancer 100:2555–61.PubMedCrossRefGoogle Scholar
  60. 60.
    Jones, J. L., K. Zabicki, R. L. Christian, M. A. Gadd, K. S. Hughes, B. A. Lesnikoski, et al. 2005. A comparison of sentinel node biopsy before and after neoadjuvant chemotherapy: timing is important. Am J Surg 190:517–20.PubMedCrossRefGoogle Scholar
  61. 61.
    Mamounas, E. P., A. Brown, S. Anderson, R. Smith, T. Julian, B. Miller, et al. 2005. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 23:2694–702.PubMedCrossRefGoogle Scholar
  62. 62.
    Newman, E., M. Sabel, A. Nees, K. Diehl, V. Cimmino, A. Chang, et al. 2007. Sentinel lymph node biopsy following neoadjuvant chemotherapy is accurate in patients with documented nodal metastases at presentation. Ann Surg Oncol 14:2946–52.PubMedCrossRefGoogle Scholar
  63. 63.
    Stearns, V., C. A. Ewing, R. Slack, M. F. Penannen, D. F. Hayes, T. N. Tsangaris. 2002. Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol 9:235–42.PubMedCrossRefGoogle Scholar
  64. 64.
    Scholl, S. M., A. Fourquet, B. Asselain, J. Y. Pierga, J. R. Vilcoq, J. C. Durand, et al. 1994. Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6. Eur J Cancer 30A:645–52.PubMedCrossRefGoogle Scholar
  65. 65.
    Scholl, S. M., B. Asselain, T. Palangie, T. Dorval, M. Jouve, E. Garcia Giralt, et al. 1991. Neoadjuvant chemotherapy in operable breast cancer. Eur J Cancer 27:1668–71.PubMedCrossRefGoogle Scholar
  66. 66.
    Scholl, S. M., J. Y. Pierga, B. Asselain, P. Beuzeboc, T. Dorval, E. Garcia-Giralt, et al. 1995. Breast tumour response to primary chemotherapy predicts local and distant control as well as survival. Eur J Cancer 31A:1969–75.PubMedCrossRefGoogle Scholar
  67. 67.
    Powles, T. J., T. F. Hickish, A. Makris, S. E. Ashley, M. E. O’Brien, V. A. Tidy, et al. 1995. Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol 13:547–52.PubMedGoogle Scholar
  68. 68.
    Makris, A., T. J. Powles, S. E. Ashley, J. Chang, T. Hickish, V. A. Tidy, et al. 1998. A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer. Ann Oncol 9:1179–84.PubMedCrossRefGoogle Scholar
  69. 69.
    Makris, A., T. J. Powles, M. Dowsett, C. K. Osborne, P. A. Trott, I. N. Fernando, et al. 1997. Prediction of response to neoadjuvant chemoendocrine therapy in primary breast carcinomas. Clin Cancer Res 3:593–600.PubMedGoogle Scholar
  70. 70.
    Semiglazov, V. F., E. E. Topuzov, J. L. Bavli, V. M. Moiseyenko, O. A. Ivanova, I. K. Seleznev, et al. 1994. Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb-IIIa breast cancer. Ann Oncol 5:591–5.PubMedGoogle Scholar
  71. 71.
    van der Hage, J. A., C. J. van de Velde, J. P. Julien, M. Tubiana-Hulin, C. Vandervelden, L. Duchateau. 2001. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 19:4224–37.PubMedGoogle Scholar
  72. 72.
    Gazet, J. C., H. T. Ford, R. Gray, C. McConkey, R. Sutcliffe, J. Quilliam, et al. 2001. Estrogen-receptor-directed neoadjuvant therapy for breast cancer: results of a randomised trial using formestane and methotrexate, mitozantrone and mitomycin C (MMM) chemotherapy. Ann Oncol 12:685–91.PubMedCrossRefGoogle Scholar
  73. 73.
    Danforth, D. N., Jr., K. Cowan, R. Altemus, M. Merino, C. Chow, A. Berman, et al. 2003. Preoperative FLAC/granulocyte-colony-stimulating factor chemotherapy for stage II breast cancer: a prospective randomized trial. Ann Surg Oncol 10:635–44.PubMedCrossRefGoogle Scholar
  74. 74.
    Schwartz, G. F., A. J. Meltzer. 2003. Accuracy of axillary sentinel lymph node biopsy following neoadjuvant (induction) chemotherapy for carcinoma of the breast. Breast J 9:374–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Tafra, L., K. M. Verbanac, D. R. Lannin. 2001. Preoperative chemotherapy and sentinel lymphadenectomy for breast cancer. Am J Surg 182:312–5.PubMedCrossRefGoogle Scholar
  76. 76.
    Brady, E. W. 2002. Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer. Breast J 8:97–100.PubMedCrossRefGoogle Scholar
  77. 77.
    Piato, J. R., A. C. Barros, K. M. Pincerato, A. P. Sampaio, J. A. Pinotti. 2003. Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study. Eur J Surg Oncol 29:118–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Lisa A. Newman
    • 1
  1. 1.Breast Care CenterUniversity of Michigan Comprehensive Cancer CenterAnn ArborUSA

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