Symbolic image of a woman empowered by breast cancer treatment.

Breast Cancer Treatment: Can Chemo Before Surgery Make a Difference?

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"Exploring the Long-Term Benefits of Neoadjuvant Chemotherapy in cT2 N0/1 Breast Cancer Patients"

For women diagnosed with breast cancer, the treatment journey can feel overwhelming. One key decision involves the timing of chemotherapy: Should it come before or after surgery? Neoadjuvant chemotherapy, meaning chemo before surgery, has emerged as a valuable strategy, particularly for those with large operable breast cancers.

Originally introduced in the 1990s, neoadjuvant chemotherapy offers several potential advantages. It can shrink tumors, making breast-conserving surgery possible for more patients. Moreover, how the cancer responds to chemo provides vital information about long-term outcomes.

But is chemo before surgery the right choice for everyone? A retrospective study published in the European Journal of Surgical Oncology sheds light on this question, investigating the long-term results of neoadjuvant chemotherapy in patients with cT2 N0/1 breast cancer.

Unpacking the Research: Long-Term Results of Chemo Before Surgery

Symbolic image of a woman empowered by breast cancer treatment.

The study, conducted between 2002 and 2007, followed 317 patients with cT2 N0/1 breast cancer who received primary chemotherapy followed by surgery. The researchers divided the patients into three groups based on their axillary treatment approach (treatment of the lymph nodes under the arm):

Here's how the study divided patients:

Upfront Axillary Dissection (AD): 101 patients underwent immediate removal of axillary lymph nodes.
Sentinel Node Biopsy + AD (SNB+AD): 139 patients had a sentinel node biopsy (removal of the first few lymph nodes to see if cancer has spread). Depending on the results of this biopsy, they then had further axillary dissection.
Sentinel Node Biopsy Only (SNB-only): 77 patients underwent sentinel node biopsy only, and no further axillary treatment if the sentinel nodes were clear of cancer.

The study examined overall survival (OS), disease-free survival (DFS), and axillary failure rates across these groups. After a median follow-up of over seven years, the results revealed:

The Bottom Line: Is Chemo Before Surgery Right for You?

This research offers valuable insights for women facing breast cancer treatment decisions. The study suggests that sentinel node biopsy is an adequate approach for T2 patients who become cN0 after primary chemotherapy, irrespective of axillary status before chemotherapy.

Ultimately, the optimal treatment strategy depends on individual circumstances, tumor characteristics, and response to chemotherapy. Discussing these findings with your oncologist is crucial to determine the best course of action for your specific situation.

The information provided in this article is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.ejso.2017.07.023, Alternate LINK

Title: Sentinel Node Biopsy After Primary Chemotherapy In Ct2 N0/1 Breast Cancer Patients: Long-Term Results Of A Retrospective Study

Subject: Oncology

Journal: European Journal of Surgical Oncology

Publisher: Elsevier BV

Authors: G. Martelli, R. Miceli, S. Folli, E. Guzzetti, C. Chifu, I. Maugeri, C. Ferranti, G. Bianchi, G. Capri, M.L. Carcangiu, B. Paolini, R. Agresti, C. Ferraris, D. Piromalli, M. Greco

Published: 2017-11-01

Everything You Need To Know

What is neoadjuvant chemotherapy and why is it used before surgery for breast cancer?

Neoadjuvant chemotherapy is administered before surgery to shrink tumors, potentially enabling breast-conserving surgery. It also allows doctors to assess how the cancer responds to chemotherapy, which provides crucial information about the likely long-term success of the treatment.

Who were the participants in the study, and what does cT2 N0/1 breast cancer mean?

The *European Journal of Surgical Oncology* study focused on patients with cT2 N0/1 breast cancer, meaning they had tumors of a certain size (T2) and may or may not have had cancer spread to a limited number of lymph nodes (N0/1). The study investigated if sentinel node biopsy is adequate for T2 patients who become cN0 after primary chemotherapy.

In the research, how were patients grouped, and why is that important?

The study divided patients into three groups based on their axillary treatment: Upfront Axillary Dissection (AD), Sentinel Node Biopsy + AD (SNB+AD), and Sentinel Node Biopsy Only (SNB-only). The choice of axillary treatment impacts the extent of lymph node removal, potentially affecting the risk of lymphedema and other complications.

What are overall survival, disease-free survival, and axillary failure rate, and why are they significant in cancer treatment?

Overall survival refers to the percentage of patients who are still alive after a certain period. Disease-free survival indicates the percentage of patients who are alive without any signs of cancer recurrence after treatment. Axillary failure rate refers to the percentage of patients who experience a recurrence of cancer in the axillary lymph nodes after initial treatment. These are important metrics to track the success of cancer treatment.

What is the main takeaway from the research, and what does it mean for treating breast cancer patients?

The study suggests that sentinel node biopsy is an adequate approach for T2 patients who become cN0 after primary chemotherapy, irrespective of axillary status before chemotherapy. This implies that less aggressive axillary surgery may be sufficient for these patients, potentially reducing the risk of complications like lymphedema, without compromising long-term outcomes. However, it's important to remember that individual treatment decisions should always be made in consultation with a medical oncologist and surgeon, considering the specifics of each case.