Neoadjuvantti

Neoadjuvantti, or neoadjuvant therapy, is treatment administered before the main definitive treatment, typically surgery, with the goal of reducing tumor size or extent. It may involve chemotherapy, radiotherapy, endocrine therapy, immunotherapy, or targeted therapies given before operation. The intention is to improve resectability, enable organ-preserving strategies, and address microscopic disease early. Neoadjuvant therapy can also provide information about tumor biology based on treatment response.

Neoadjuvant approaches are used in various solid tumors, including breast cancer, rectal cancer, esophageal cancer, stomach cancer, pancreatic cancer, and ovarian cancer. In breast cancer, neoadjuvant chemotherapy or endocrine therapy can shrink tumors to permit lumpectomy; in rectal cancer, neoadjuvant chemoradiation increases the chance of complete resection and reduces local recurrence. In other cancers, neoadjuvant treatment aims to convert unresectable tumors to resectable status or to eradicate micrometastatic disease. A pathologic complete response after neoadjuvant therapy is a favorable prognostic indicator in some cancers, though the correlation varies by tumor type.

Treatment planning is coordinated by a multidisciplinary team and based on initial staging, tumor biology, and patient factors. After completing the neoadjuvant regimen, patients undergo restaging with imaging and then surgery when feasible; pathologic response is assessed in the resected specimen, guiding further therapy. Neoadjuvant regimens increasingly include combinations of chemotherapy with targeted agents or immunotherapy, tailored to tumor characteristics and clinical guidelines.

Advantages of neoadjuvant therapy include tumor downstaging, increased likelihood of organ-preserving procedures, and earlier systemic treatment. Potential drawbacks include the risk of treatment-related toxicity causing surgical delays, progression during therapy, or nonresponse. Decisions are individualized and guided by evidence from clinical trials and guidelines for each cancer type.