Locally advanced breast cancer

Abstract

Locally advanced breast cancer (LABC) is defined here as inoperable breast adenocarcinoma without distant metastases. Patients with LABC require a multidisciplinary approach. Given the risk of distant metastasis, staging exams are necessary. The incidence of LABC (stages IIIB and IIIC) has decreased in recent years. LABC has rarely been investigated separately: patients with LABC have participated both in clinical trials of palliative and of neoadjuvant therapy. Most trials did not analyze responses and longterm outcomes independently; thus, the treatment of patients with LABC is extrapolated from studies of patients with less or more advanced disease. Pathologic confirmation and molecular profiling are essential for the choice of neoadjuvant chemotherapy. Preoperative endocrine therapy may be considered in certain clinical situations; the addition of a CDK4/6 inhibitor is being investigated. HER2 positive LABCs are targeted with anti-HER2 agents combined with chemotherapy. PD-1 and PD-L1 antibodies in 'triple-negative' LABC are promising. Excellent responses to neoadjuvant therapy enable conservative surgery in many patients; however, inflammatory breast cancer may still indicate mastectomy. Postoperative radiotherapy is usually indicated. Target volumes include breast/chest wall, axillary, supraclavicular and internal mammary nodal basins. Preoperative radiation therapy can be useful in patients without response to systemic therapies. Palliative surgery for poor responders after neoadjuvant systemic and radiation therapy can be considered. Multidisciplinary teams can optimize local control and prevent relapses. However, modest improvement in survival was achieved between 2000 and 2014 underscoring the unmet need in patients with LABC who will benefit from specific research efforts in this disease entity.

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting

“…The two groups showed similar biological characteristics and tumor subtype. As reported in the literature [12][13][14], in our case series, the presence of inflammatory carcinoma (cT4d) was more frequently subjected to RBS (46.7% vs. 13.7%-p < 0.001), while 70.7% of patients with cT4b underwent conservative surgery, with the only indication to remove the skin or muscle area involved by cancer. The only case of cT4a also received conservative surgery, removing the muscle's area involved by the neoplasm that resulted without cancer residue for complete pathological response.…”

“…Nowadays, there is an unclear consensus as to whether conservative surgery can be performed in patients with cT4a-d stage. Therefore, the treatment of these BC stages is based almost exclusively on radical breast surgery (RBS) and in a smaller number of cases on surgery conservation [2,3,12,13]. CBS is recommended especially in patients responsive to NA.…”

Development and Validation a Survival Prediction Model and a Risk Stratification for Elderly Locally Advanced Breast Cancer

“…Locally advanced breast cancer (LABC) is a heterogeneous disease with multiple clinical manifestations and a relatively poor prognosis, and its precise management remains an important clinical challenge. [1][2][3][4][5] At M.D. Anderson Cancer Center, LABC was defined as breast cancer with maximum diameter of primary tumor ≥ 5 cm and/or involvement of the skin, chest wall, or disease presenting with 4 or more lymph node metastases, ie.., stage T3N0M0 or stage III.…”

The use of Hybrid Techniques in Whole-Breast Radiotherapy: A Systematic Review

“…4 Advances in surgery and systemic therapy are gradually improving survival in breast cancer. 5 Lumpectomy (surgery to remove cancerous tissue from the breast) is usually performed on early stage breast cancer patients. Postoperative RT in the treatment of breast cancer has been shown to significantly reduce the risk of local recurrence and also improve long-term survival.…”