Chemotherapy more effective when given before breast cancer surgery

d on the postoperative and thus 'blind' administration of chemotherapy to patients with tumors resistant to a specific chemotherapy regimen," Mieog said. "These patients will receive all chemotherapy courses while only experiencing the harmful side effects."

Side effects such as hair loss, cardiac symptoms, nausea and vomiting, and white blood cell disorders were similar for both groups, the Cochrane reviewers found.

"Initially, preoperative chemotherapy was set up to improve overall survival by not waiting for the surgical procedure and the subsequent recovery a couple of months means one or two [cancer] cell divisions," Mieog said.

He added, "The chemotherapy also increased the breast conservation rate; it is well known that conserving the breast as compared to mastectomy is associated with an increased recurrence rate, without, however, hampering long-term overall survival."

"It is important to evaluate issues of timing and specifically consider the advantages of preoperative chemotherapy," said Terry Mamounas, M.D., medical director of the Mount Sinai Center for Breast Health in Cleveland.

Earlier studies suggest "a correlation between tumor response with preoperative chemotherapy and relapse-free survival," Mamounas said. He added that the response to preoperative chemotherapy can give clues about the outcome of the therapy and help guide further treatment.

The Cochrane review showed that tumors shrank more in some of the women who received preoperative chemotherapy than in others. "Different factors could have influenced the reported rates," the researchers write, "including definition of response, blinding of assessor, method and type of assessment, study population and type of chemotherapy used."

"The most appropriate method of clinical tumor response assessment remains a matter of debate," they add.

The researchers say that preoperative chemotherapy is currently the standa

Contact: Lisa Esposito
Center for the Advancement of Health

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