Abstract:

In recent years, neoadjuvant chemotherapy (NAC), as a standard treatment for patients with locally advanced breast cancer, has made inoperable patients operable, and has given the opportunity of breast conserving surgery to patients with indication for breast resection. In addition, NAC can downstage axillary region, leading to the exemption of axillary lymph node dissection. With more precise molecular subtyping of breast cancer, the efficacy of NAC has been continuously improved. However, it is still necessary to improve the local treatment after NAC and carry out precise individualized treatment according to the tumor burden of primary tumor and locoregional area of the axilla and the effectiveness of the first NAC, so as to bring patients higher quality of life and more survival benefits. Based on the accurate assessment of locoregional areas of breast cancer, the optimal treatment for locoregional areas of breast cancer after NAC violates the previous view. There are some controversies on whether the patients with downstaged breast lesions and axilla can be treated with de-escalating strategy after NAC (such as exemption from lymph node biopsy, dissection, radiotherapy). This paper reviewed the latest clinical studies and summarized the optimal staging evaluation and the selection of surgical and radiotherapy in locoregional areas including primary breast lesions and axillary areas after NAC, in order to provide evidences for clinicians in dealing with such cases.

Key words: Breast neoplasms, Neoadjuvant chemotherapy, Sentinel lymph node biopsy, Axillary lymph node dissection, De-escalating