Henry Kuerer, MD, PhD
The concept of de-escalating surgical therapy for breast cancer continues to find acceptance. This is an exhilarating and potentially pivotal time in the management of invasive breast cancer, as we begin to test the new paradigm that not all patients need surgery for the management of their malignancy after neoadjuvant systemic therapy.
Proceeding With Caution
Patients should not be offered elimination of surgery after neoadjuvant systemic therapy unless they are on a prospective clinical trial, as the safety of this approach has not been proved yet. The key here is the optimal, accurate, and safe selection of patients who have had a pathologic complete response (pCR), which is no residual invasive or in situ carcinoma after neoadjuvant systemic therapy. If there is no detectable residual disease among patients who will be receiving radiotherapy, the benefit of surgery would appear to be very low and potentially unnecessary.
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