Chemotherapy given before surgery to remove cancer is called neoadjuvant treatment. An oncologist might recommend this based of the size of the tumor -- it being very large. The idea is to shrink the tumor and then have surgery to remove the cancer.

Having chemotherapy administered while the tumor is still there can show what drugs are working and what drugs have no effect on the tumor. Chemotherapy when started immediately, not after surgery with healing time needed, gives the patient systematic treatment right away. This could be beneficial and is why physicians might recommend this form of treatment. The truth is they don't know if it is better or not.

Of course, every case of breast cancer is different. We all need to make tough decisions regarding our treatment plan. The facts are that currently there is no evidence that survival is improved with neoadjuvant verses adjuvant (after surgery) chemotherapy in women with locally advanced breast cancer.

The clinical trials that are done help physicians understand what treatments are more effective. Results from a Phase II clinical trial was published in the Journal of Clinical Oncology. It stated that neoadjuvant treatment with Taxotere, Navelbine, and Herceptin resulted in a complete disappearance of detectable cancer in 39 percent of women with locally advanced HER2 positive breast cancer.

The study showed that after two years followup, on the thirty one women with locally advanced breast cancer involved in the study, the overall survival was 97 percent and cancer free survival was 84 percent.

So, the message here is that, even though the study group was small, the results showed a good response to this treatment plan.

Stage IIIB breast cancer describes invasive breast cancer in which a tumor of any size has spread to the breast skin, chest wall, or internal mammary lymph nodes. It also includes inflammatory breast cancer, a very uncommon but very serious, aggressive type of breast cancer.

Patients diagnosed with Stage IIIB breast cancer usually will receive chemotherapy before surgery and then possibly radiation, hormonal therapy, and more chemotherapy after surgery.

Those who receive a complete disappearance of all detectable cancer from receiving the chemotherapy before surgery have a better survival rate than those who have evidence of cancer after the neoadjuvant treatments. Researchers want to try and improve survival for those who have not had a complete response to the treatments before surgery.

Researchers from Italy conducted a trial to evaluate the effects of additional chemotherapy after surgery to see if this will give these patients a better chance at cancer free survival.

The participants were followed for over six years:

• Cancer free survival was 92 percent among patients who had a complete response from neoadjuvant treatment.
• Patients that still had detectable cancer after neoadjuvant treatment had only a 53 percent cancer free survival.
• Those patients that did not have a complete response after neoadjuvant therapy but went on to have more chemotherapy after surgery had 100 percent cancer free survival.

The researchers added that the trial was small but it appears that additional chemotherapy added after surgery could provide a significant survival benefit.

Rectal cancer usually involves surgery. The surgery that is performed has the possibility of causing the loss of bowel control. The idea behind giving chemotherapy before surgery (neoadjuvant) is to shrink the tumor so that the surgery will be minimal to avoid the loss of bowel control. Researchers have been evaluating the effects of chemotherapy or radiation therapy prior to surgery in attempt to combat this after effect of surgery.

The article recently published in the New England Journal of Medicine says that survival of patients with rectal cancer fair the same whether or not the chemotherapy is giving before of after surgery. Most patients with rectal cancer are usually treated with radiation before surgery.

Researches affiliated with the European Organization for Research and Treatment for Cancer (EORTC) conducted a clinical trial that included 1,011 patients with rectal cancer. The researches split the patients into four groups. Those receiving chemotherapy and radiation before surgery, those receiving only radiation before surgery, those that received radiation before surgery and chemotherapy after surgery and those that only received chemotherapy before surgery.

The five year survival rate for those who received chemotherapy before surgery and after surgery were both 65 percent. Local recurrences occurred less in those patients who received radiation plus chemotherapy before surgery.

The impact on long-term survival with the use of neoadjuvant chemotherapy has not been well established. The article did not mention if the radiation or neoadjuvant chemotherapy did at all affect the loss of bowel control after surgery.

The addition of further chemotherapy added to neoadjuvant chemotherapy in patients with esophageal cancer can improve survival. When diagnosed with esophageal cancer the patient is usually given chemotherapy to shrink the tumor before surgery, it also may be accompanied by radiation. This gives a better chance that the tumor will be smaller and can be fully removed. It also is treating the body immediately with systematic therapy in case any cancer cells are circulating in the body.

The journal Cancer has published an article from researchers at MD Anderson Cancer Center regarding additional chemotherapy added to the neoadjuvant chemotherapy already given to patients who have locally advanced esophageal cancer.

The study included 130 patients with esophageal cancer who received neoadjuvant chemotherapy plus radiation therapy and their outcomes were compared to 117 patients who received the same treatment plus and additional course of chemotherapy (induction chemotherapy) prior to surgery.

At five years overall survival was 43 percent for those treated with the additional induction chemotherapy before surgery, compared to 28 percent for those not treated with induction chemotherapy.

The researchers concluded that the induction chemotherapy added to the neoadjuvant chemotherapy improved survival.