neoadyuvantes

Neoadyuvantes, or neoadjuvant therapies, are treatments administered before the main therapeutic intervention, most often before surgical resection. The aim is to shrink or downstage the tumor, increase the likelihood of complete removal with negative margins, and address micrometastatic disease earlier in the course of care. Neoadjuvant approaches can also provide information about tumor biology based on early response.

The available modalities include chemotherapy, radiotherapy, chemoradiotherapy, and, in some settings, targeted therapy, endocrine therapy, or immunotherapy. The choice of modality depends on tumor type, stage, location, patient factors, and local practice patterns. Neoadjuvant therapy is commonly used in cancers where organ preservation or less extensive surgery is possible, or where upfront surgery would be less effective or riskier.

Common indications include locally advanced breast cancer, rectal cancer, esophageal cancer, and certain head and neck or gastric cancers, as well as some sarcomas and bladder cancers. Goals include enabling complete surgical resection, reducing the extent of surgery, and treating systemic disease early. Response to therapy is monitored with imaging, clinical assessment, and, when available, pathological evaluation after resection, with pathologic complete response serving as a favorable prognostic indicator in several diseases.

Neoadjuvant therapy is distinct from adjuvant therapy, which is given after the primary treatment to eradicate residual disease. Selection of neoadjuvant strategies requires careful consideration of risks, benefits, and patient preferences.