Primary chemotherapy in the individualized non-mutilating treatment of breast cancer

Abstract

Primary chemotherapy is not well known nor recognized as a good local treatment of breast cancer because it is used mainly to destroy micrometastases at distance, (the same applies to anti-hormonal agents) [2–12–13]. Although different and not really comparable to radiotherapy or surgery, it is increasingly improving both at the systemic and local levels. We have observed that many women with inflammatory breast carcinoma and/or locally advanced breast cancer experienced a dramatic clinical tumour volume reduction after primary chemotherapy [1–7–10], so much so that the cancerocidal radiotherapy given in second line in the high responder patients might eliminate the need for surgery, in a good subset of them. However, for smaller lesions or less advanced cases, except for the French school of Jacquillat [8–9], fewer studies have been performed along these lines. Not all breast tumours respond to primary chemotherapy in the same fashion, on account of their great heterogeneity. In our experience, the high primary chemotherapy responder patients are more inclined to also respond well to radiotherapy and conversely. In poor or mediocre responder patients, a tumorectomy or a wide local excision can handle the situation more quickly. In that respect, a certain flexibility is mandatory.