Neoadjuvant Chemotherapy in Breast Cancer: An Advanced Personalized Multidisciplinary Prehabilitation Model (APMP-M) to Optimize Outcomes

Abstract

Neoadjuvant chemotherapy is increasingly being employed in the management of breast cancer patients. Efforts and resources have been devoted over the years to the search for an optimal strategy that can improve outcomes in the neoadjuvant setting. Today, a multidisciplinary approach with the application of evidence-based medicine is considered the gold standard for the improvement of oncological results and patient satisfaction. However, several clinical complications and psychological issues due to various factors can arise during neoadjuvant therapy and undermine outcomes. To ensure that health care needs are adequately addressed, clinicians must consider that women with breast cancer have a high risk of developing “unmet needs” during treatment, and often require a clinical intervention or additional care resources to limit possible complications and psychological issues that can occur during neoadjuvant treatment. This work describes a multidisciplinary model developed at “Fondazione Policlinico Universitario Agostino Gemelli” (FPG) in Rome in an effort to optimize treatment, ease the application of evidence-based medicine, and improve patient quality of life in the neoadjuvant setting. In developing our model, our main goal was to adequately meet patient needs while preventing high levels of distress.

Accuracy and Limitations of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients with Positive Nodes

“…In addition, the efforts in de-escalating surgical procedures may be combined with adjusted, optimized, and individualized systemic treatments without a detrimental impact on the quality of life [ 36 ]. Updated results from the TAXIS and Alliance A11202 (ClinicalTrials.gov Identifier: NCT01901094) studies with disease-free and overall survival data are awaited.…”

Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience

“…Loco-regional staging was performed by: Clinical breast examination with the acquisition of two photographs in the frontal and lateral views of the patient’s breasts, with a mark on the skin surface depicting tumor projection and measurements [ 17 ]; Breast and axillary ultrasound (EUS); Mammography with tomosynthesis and/or mammography with contrast medium (CESM); Magnetic resonance image (MRI) with contrast medium; Breast fine needle aspiration biopsy to assess the histotype and biological features; markers were positioned in the breast tissue to ensure pre-surgical localization in the case of pathological complete response (pCR) or regression to a non-palpable lesion [ 17 ]; Suspicious axillary lymph node fine needle aspiration biopsy or cytology; markers were always positioned in pathologic lymph nodes. …”

“…Clinical breast examination with the acquisition of two photographs in the frontal and lateral views of the patient’s breasts, with a mark on the skin surface depicting tumor projection and measurements [ 17 ];…”

“…Breast fine needle aspiration biopsy to assess the histotype and biological features; markers were positioned in the breast tissue to ensure pre-surgical localization in the case of pathological complete response (pCR) or regression to a non-palpable lesion [ 17 ];…”

“…The diffusion of OPSII in clinical practice comes from preliminary reported data that seem to indicate an adequate oncological safety and aesthetic efficacy when compared to standard breast conserving-surgery (BCS) [ 3 , 4 , 7 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”