Locally Advanced Breast Cancer

Abstract

Locally advanced breast cancer encompasses a heterogeneous collection of breast neoplasms and constitutes approximately 10%-20% of the newly diagnosed breast cancers. These cancers may have widely different clinical and biological characteristics. Patients with these tumors may be classified as stage IIB, III or IV breast cancer according to the American Joint Committee for Cancer Staging and End Results Reporting (TNM classification). Multidisciplinary therapy has become the treatment of choice for these patients. Primary or neoadjuvant chemotherapy followed by locoregional therapy, either surgery and/or radiotherapy, and postoperative systemic chemotherapy is now an accepted strategy. More than 70% of patients achieve an objective response (including pathological complete remission in 10%-25% of cases), and many patients experience downstaging through primary chemotherapy. Breast conservation is possible in 10%-40% of patients with locally advanced breast cancer; almost all patients initially are rendered disease-free, and long-term local control is achieved in over 70% of these patients. Primary chemotherapy is the initial choice of treatment for patients with locally advanced tumors, but it is unclear what the optimal sequence of subsequent therapies should be, whether one or two local treatment modalities are necessary, and whether any or different postoperative chemotherapy is needed. The efficacy of primary chemotherapy was demonstrated in several large prospective studies in patients with locally advanced breast cancer. The natural history of this disease was changed dramatically by the introduction of these combined modality therapies. Five-year disease-free survival rates of 35%-70% are commonly reported, and about 25%-40% of patients will survive beyond 10 years without recurrence. In summary, multidisciplinary therapy that includes primary chemotherapy provides appropriate local control and the possibility of breast conservation therapy; it increases surgical resectability and survival rates in patients with locally advanced breast cancer. The role of new innovative therapeutic strategies such as high-dose chemotherapy, with hematopoietic stem cell rescue, new cytotoxic agents and higher dose-intensity therapy is currently under evaluation in patients with locally advanced breast cancer.

Prolonged Neoadjuvant Chemotherapy with GM-CSF in Locally Advanced Breast Cancer

“…Patients with locally advanced breast cancer (LABC) have a poor prognosis when treated with surgery and/or radiotherapy [1][2][3]. These tumors include stage IIIA and IIIB breast cancer according to the American Joint Committee on Cancer (AJCC) [4].…”

Multimodality treatment of 128 patients with locally advanced breast carcinoma in the era of mammography screening using standard polychemotherapy with 5-fluorouracil, epirubicin, and cyclophosphamide

“…Locally advanced breast carcinomas (LABCs) constitute 10‐29% of all breast carcinomas in industrialized countries 1, 2. The corresponding figures for Sweden in the era of mammography screening were 6.0% and 4.4% in 1989 and 1995, respectively (unpublished data from the South Swedish Breast Cancer Registry).…”

Multidisciplinary Therapy of Locally Far-Advanced or Inflammatory Breast Cancer with Fixed Perioperative Sequence of Epirubicin, Vinorelbine, and Fluorouracil Chemotherapy, Surgery, and Radiotherapy: Long-Term Results

“…The high percentage of radically operated patients should be attributed to the far-advanced stage at presentation, although in almost one third of the patients, conservative surgery was judged feasible. To our knowledge, this conversion-to-operability rate is among the highest reported in the literature [6][7][8][9][10][11][48][49][50][51][52], given the advanced stage of almost all cases and the presence of an inflammatory component in 25% of them. The short-term local control rate was influenced by the amount of preoperative chemotherapy administered, while postoperative chemotherapy seemed to enhance long-term systemic disease control.…”