NSABP B-18 Trial

  • The NSABP B-18 trial:
    • Was initiated in 1988 to determine:
      • Whether four cycles of doxorubicin and cyclophosphamide given preoperatively:
        • Improved survival and DFS:
          • When compared with the same chemotherapy given postoperatively
        • Secondary aims included:
          • The evaluation of preoperative chemotherapy:
            • In downstaging the primary breast tumor and involved axillary lymph nodes
    • Women aged 50 years or older:
      • Also received tamoxifen for 5 years
    • The results of the trial showed that:
      • With preoperative chemotherapy:
        • 36% of patients:
          • Achieved a clinical complete response
        • 43% of patients:
          • Achieved a clinical partial response
        • 13% of patients:
          • Achieved a pathologic complete response
      • Patients who received preoperative chemotherapy:
        • Were more likely to receive breast-conserving surgery:
          • 67% vs 60%:
            • Than patients receiving postoperative chemotherapy
      • There was no difference in:
        • DFS
        • Distant DFS
        • Overall survival:
          • Between the two groups
    • At 9 years:
      • The rate of ipsilateral breast tumor recurrence:
        • Was numerically higher in the preoperative chemotherapy group than the postoperative chemotherapy group (10.7% vs 7.6%):
          • Although this difference was not statistically significant (P=0.12)


  1. Fisher ER, Wang J, Bryant J, Fisher, Mamounas E, Wolmark N. Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. Cancer. 2002;95:681-695.
  2. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001:96-102.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastCancer #Surgeon #Teacher

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