What Is Neoadjuvant Treatment? A Strategic Move Before Surgery

What Is Neoadjuvant Treatment?

Neoadjuvant treatmentin cancer care refers to a systemic approach before surgery or the main treatment . This strategy was developed to shrink the tumor, control microscopic metastases (micrometastases) and improve long-term survival. Today it has become breast, rectal, lung, esophageal and stomach cancers are among the many tumor types in which it has become a standard treatment step.

🔍 The Difference Between Neoadjuvant and Induction Chemotherapy

• Neoadjuvant treatment: Includes systemic treatments given in relation to a main treatment such as surgery or radiotherapy, before it takes place as the preceding treatment stage.
• Induction chemotherapy: Independent of surgery, it is systemic treatment before the main treatment and is generally administered before radiotherapy.

Purpose and Effects of Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy does more than facilitate surgery; it is also critically important for measuring treatment response and strategically planning subsequent steps:

• 🏥 Facilitates surgery: Shrinks the tumor, increasing the likelihood of organ-preserving surgery being possible.
• 🔬 Micrometastasis control: Targets foci that cannot be detected with imaging methods.
• 📊 Pathological response assessment (pCR): The absence of viable cells in the tumor is a strong indicator of long-term survival.
• 🌱 Treatment tolerance: Chemotherapy is generally better tolerated before surgery.

📈 Effectiveness Based on Scientific Evidence

• According to large-scale analyses, 5-year overall survival in patients achieving pCR is %63, compared with %39 in those without pCR [Rosner et al., 2022].
• Disease-free survival: %80.1 (pCR) vs %44.8 (no pCR), p<0.0001 [Wolmark et al.].
• CheckMate 816 study: in NSCLC, nivolumab + chemotherapydoubled the pCR rate, and at 2 years EFS reached %90as the reported result [Forde et al., 2023].

📊 Key Numbers

Conclusion and Future Perspective

Neoadjuvant treatment is a critical step not only for shrinking the tumor, but also for measuring treatment's biological effects to develop personalized treatment plans . While adding immunotherapies during the neoadjuvant period increases the survival advantage, measures such as pathological complete response will be central to guiding treatment in the future. With appropriate patient selection and individual planning by multidisciplinary teams, this approach will continue changing paradigms in cancer treatment.