Abstract

Primary chemotherapy has gained an increasingly prominent role in the treatment of breast cancer. It has potential advantages which includes operation of the inoperable tumors, direct evaluation of the response and organ sparing. Primary chemotherapy results in tumour regression in a large majority of patients with clinical response rates 70-90%. In inflammatory breast cancer combining doxurubisin-containing chemotherapy with mastectomy or radiation therapy improves survival over that achieved with mastectomy or irradiation alone. Prognostic factors which determine the response to the primary chemotherapy are T stage and nodal status. The amount of residual tumor after the primary chemotherapy is the most important prognostic factor which determines the survival. Preoperative chemotherapy sufficiently downstages disease in patients with locally advanced breast cancer to allow breast-conservation surgery. Determination of the potential benefits in terms of disease free and overall survival in noninflammatory breast cancer compared to other schedules combining surgery radiotherapy and systemic therapy will require large, randomised trials. New prognostic factors must be determined for the evaluation of the primary chemotherapy.