Breast Conservation after Neoadjuvant Chemotherapy



Risk Factors

Presentation and Evaluation



Clinical Presentation

Routes of Spread

Diagnostic Studies




Prognostic Factors



NSABP B-18 (Wolmark JNCI 01, Fisher JCO 97)

  • Chemotherapy: four cycles of doxorubicin (60 mg/m2)/cyclophosphamide(600 mg/m2) (AC) chemotherapy every 21 days
  • Surgery: lumpectomy and axillary lymph node dissection or modified radical mastectomy
  • Radiation: Given for patients with lumpectomies
  • Pre-op regiment: ACx4/TAM x 5 year - Surgery - RT (if lumpectomy)
  • Post-op regiment: Surgery - AC x 4 - RT(if lumpectomy) - TAM x 5 years


Groups 9-OS 9-DFS IBRT Lumpectomy
pre-op 69% 55% 10.7% 59.8%
post-op 70% 53% 7.6% 67.8%
p-value N.S. N.S. N.S.


  • 12% more lumpectomies in preoperative group
  • > 20% of patients who were initially considered unresectable become resectable after chemotehrapy
  • Ipsilateral breast tumor recurrence was higher in pre-operative group 10.7% 7.6%, but not statistically significant.
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2. Gunderson L, Tepper J: Clinical Radiation Oncology. 2nd ed. China: Elsevier 2007.
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4. Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997 Jul;15(7):2483-93.
PMID: 9215816
5. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;(30):96-102. PMID: 11773300
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