Neoadjuvant chemotherapy refers to the initial systemic treatment for patients who present with localised cancer for whom there is an alternative but less than completely effective local treatment. There are a multiple reasons for the use of neoadjuvant chemotherapy, but, there may be potential disadvantages. Several neoplasms in which neoadjuvant chemotherapy, if effective, can allow less mutilating surgery and neoplasms in which clinical trials indicate an expanding role for neo-adjuvant therapy are discussed.