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What is the most indicated surgery after neoadjuvant chemotherapy?

All patients should undergo surgery after systemic neoadjuvant therapy, even if they have a complete clinical and/or radiological response. Patients who progress during neoadjuvant systemic therapy can change their chemotherapy regimen or proceed with surgery.

The choice between breast conservation and mastectomy after neoadjuvant treatment depends on the response to treatment and the patient's characteristics (eg, breast size in relation to residual tumor size). Similar criteria used in the treatment of early-stage breast cancer apply. However, patients who present with a large breast lesion (ie, T4) must undergo a mastectomy, after neoadjuvant treatment, even with a complete response.

How to approach axillary lymph nodes after neoadjuvant chemotherapy?

When there is complete clinical response, the sentinel lymph node technique can be used. In cases of clinically compromised early axillary lymph nodes, puncture, biopsy and placement of a metal clip are recommended to facilitate future identification.

The risk of axillary lymph node metastases is related to tumor size and location, histological grade, and presence of lymphatic invasion in the primary tumor.

What is the adjuvant therapy after surgery for locally advanced tumor?

Patients who have not received neoadjuvant systemic therapy should receive adjuvant treatment. The use of chemotherapy, biological therapy, and/or endocrine therapy is guided by the same principles used to determine treatment for early-stage breast cancer.

For patients who have received the full course of neoadjuvant chemotherapy it is very important to assess the pathological response. If the response is incomplete (residual disease), complementary adjuvant chemotherapy is recommended. In cases of complete pathological response, there is no indication for adjuvant chemotherapy.

Hormone receptor positive breast cancer patients should receive endocrine therapy to reduce the risk of breast cancer recurrence

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Sorocaba Medical Center


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Tel. 21 2537-0138 / 2539-5093

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Americas Medical City

Barra da Tijuca

Av. Jorge Curi, 550 - rooms 252/253

Tel. 21 3264-4866 / 3264-4863

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