Picture: Dripping IV bottle 
Before surgery chemotherapy
shows its effect on tumours
© NCI Visuals Online

Preoperative chemotherapy reduced chemo-related infections by 4 percent and the need for mastectomies by 17 percent when compared to postoperative chemotherapy, found reviewers led by Sven Mieog, M.D., of Leiden University Medical Center in the Netherlands.

Mieog and colleagues looked at 14 studies that included 5,500 women with operable breast cancer. Half of the women received preoperative chemotherapy and the rest received chemotherapy after surgery. The data revealed a higher cancer recurrence rate in women who had chemotherapy before surgery, although this did not affect survival rates, which were similar for both groups.

“Ten studies reported overall survival data on 4,620 women involving 1,139 estimated deaths,” the researchers write. “There was no detectable difference between preoperative and postoperative chemotherapy.” One reason for giving chemotherapy first is to shrink tumours before surgery, the researchers say. Moreover, preoperative chemotherapy allows doctors to see if a tumour is resistant to a particular drug and thus adjust the dose or switch to another drug after surgery.

The patient might avoid toxic side effects while getting another chance to receive appropriate systemic treatment, Mieog said. After surgery, doctors can no longer gauge chemotherapy’s effect on tumour size. Side effects such as hair loss, cardiac symptoms, nausea and vomiting, and white blood cell disorders were similar for both groups, the researchers found.

Earlier studies suggest “a correlation between tumour response with preoperative chemotherapy and relapse-free survival,” Terry Mamounas, M.D., medical director of the Mount Sinai Center for Breast Health in Cleveland said. He added that the response to preoperative chemotherapy can give clues about the outcome of the therapy and help guide further treatment.

MEDICA.de; Source: Health Behavior News Service