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Systemic therapy
Neoadjuvant therapy
Treatment before surgery, to shrink the tumour, and to see how it behaves.
What it is
Chemotherapy, chemoradiation or targeted therapy given before an operation can shrink a tumour enough to make surgery smaller, or possible at all. In breast cancer it can convert a mastectomy into breast conservation.
It also does something no other approach does: it shows you, in the living patient, whether the treatment works. A complete pathological response is among the most useful prognostic facts in oncology.
When it is used
- Locally advanced breast cancer
- Rectal cancer before surgery
- Oesophageal and gastric cancer
- Where downstaging would change the operation
- Where response information would change what follows
How the decision is made
- Whether downstaging would genuinely change the surgery, or only delay it.
- How response will be assessed, and what happens if there is none.
- The surgical window, who is holding the operating date while this runs.
Planned at the board here; delivered at a partner day-care or radiation unit; surgery at the partner centre.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- A board decision with the surgeon present before the first cycle
- Written response-assessment points and what each triggers
- Coordination so the surgical slot is not lost
- Post-operative pathology review and the next decision
Performed and billed elsewhere
- Drug administration
- Radiation delivery
- The operation
- If your tumour is growing during neoadjuvant treatment, the plan must change immediately, that is what the assessment points are for.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- Will this change the operation I need, or just delay it?
- How will we know it is working?
- Who is holding my surgery date?
- What if it does not respond?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.