Journal of Modern OncologyJournal of Modern Oncology1815-14341815-1442LLC Obyedinennaya Redaktsiya27052Research ArticleFeatures of surgical treatment of patients with breast cancer receiving preoperative systemic therapyKolyadinaI Virinakolyadina@yandex.ruPoddubnayaI V-PavlikovaO A-KomovD V-Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian FederationN.N.Blokhin Russian Cancer Research Center of the Ministry of Health of the Russian Federation15032016181505409042020Copyright © 2016, Consilium Medicum2016Preoperative systemic therapy of breast cancer is one of the most promising and rapidly developing areas of modern oncology. Effective preoperative systemic treatment modifies the subsequent surgical step, contributes to the elimination of subclinical micrometastases and carcinoma sensitivity assessment for this type of therapy. However, the main goal is to achieve complete morphological regression, as a predictor of favorable prognosis of the disease. The proportion of patients who achieved a complete tumor response to preoperative effective systemic therapy is steadily growing, which creates certain difficulties at all steps of surgical treatment due to loss of macroscopic tumor area. Placement of image-detectable marker into the primary tumor and assessment of the status of regional lymph nodes before the start of systemic therapy, preoperative demarcate the residual tumor, planning volume of removed tissue, evaluation of resection margins and clipping the tumor bed for adjuvant radiation therapy with boost is a continuous chain of modern multidisciplinary approach in the treatment of breast cancer, the need to implement in clinical practice becomes apparent.preoperative systemic therapy of breast cancerplacement of image-detectable marker into the primary tumor and lymph nodessentinel lymph node biopsyevaluation of resection marginsclipping the tumor bed for adjuvant radiation therapy with boostпредоперационная лекарственная терапия рака молочной железымаркировка первичной опухоли и лимфатических узловбиопсия сторожевого лимфатического узлаоценка краев резекцииклипирование «ложа» удаленной опухоли для подведения «буста»[Каприн А.Д. Состояние онкологической помощи населению России в 2013 году. Под ред. А.Д.Каприна, В.В.Старинского, Г.В.Петровой. М.: МНИОИ им. П.А.Герцена, 2014.][Тюляндин С.А. Системная терапия операбельного рака молочной железы. Практ. онкология. 2002; 3 (1): 29-37.][Практические рекомендации RUSSCO по лекарственному лечению злокачественных опухолей [Электронный ресурс]. М., 2015; с. 99-115. www.rosoncoweb.ru/standarts/RUSSCO/07-2.pdf][http://www.nccn.org/professionals/physician_gls/f_guidelines.asp][Layeequr Rahman R, Crawford SL, Siwawa P. Management of axilla in breast cancer - The saga continues. Breast 2015; 24 (4): 343-53. Doi: 10.1016/j.breast.2015.03.010.][Boughey J.C, Suman V.J, Mittendorf E.A et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node - positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013; 310 (14): 1455-61. Doi: 10.1001/jama.2013.278932.][Boughey J.C1, Ballman K.V, Le-Petross H.T et al. Identification and Resection of Clipped Node Decreases the False - negative Rate of Sentinel Lymph Node Surgery in Patients Presenting With Node - positive Breast Cancer (T0-T4, N1-N2) Who Receive Neoadjuvant Chemotherapy: Results From ACOSOG Z1071 (Alliance). Ann Surg 2016; 263 (4): 802-7. Doi: 10.1097/SLA.0000000000001375.][Coates A.S, Winer E.P, Goldhirsch A et al. Tailoring therapies - improving the management of early breast cancer: St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol 2015; 26: 1533-46. Doi:10.1093/annonc/ mdv221.][Houssami N, Morrow M. Margins in breast conservation: a clinician’s perspective and what the literature tells us. J Surg Oncol 2014; 110: 2-7.][Moran M.S, Schnitt S.J, Giuliano A.E et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast - conserving surgery with whole - breast irradiation in stages I and II invasive breast cancer. J Clin Oncol 2014; 32: 1507-15.][http://www.ago-online.de/en/guidelines-mamma/march-2015][Breast cancer/Dutch Guideline, version 2.0, 2012/www.oncoline.nl/ breastcancer]