Management of patients with locally advanced breast cancer

Abstract

Increased breast health awareness has led to earlier stage distribution among breast cancer patients in the United States; however, locally advanced tumors remain a major source of morbidity and mortality. Early attempts to control this high-risk pattern of disease with surgery or radiation alone were met with disappointingly high rates of treatment failure in locoregional and distant sites. Multimodality strategies represent a major advance in management of these difficult cancers. The current standard of care is neoadjuvant chemotherapy to improve operability, followed by breast and axillary surgery (including lumpectomy for appropriately selected patients). Following surgery, decisions regarding the need for additional chemotherapy with or without locoregional irradiation are made based on stage at presentation, response to systemic therapy, and surgical-pathology findings. Recommendations for adjuvant endocrine therapy are based on hormone receptor status. Studies of these tumors have confirmed that primary response to induction therapy is an excellent surrogate marker of success in eradicating micrometastases, as patients experiencing a complete pathologic response have a statistically significant survival advantage. Ongoing investigations of locally advanced breast cancer include studies of systemic chemotherapy with or without neoadjuvant endocrine regimens that increase the complete pathologic response rate, and correlation with outcome; integration of lymphatic mapping and sentinel lymph node biopsy into clinical trials; and defining the optimal extent of locoregional irradiation in patients who experience a strong response to neoadjuvant treatment.

Outcome of neoadjuvant chemotherapy in locally advanced breast cancer: A tertiary care center experience

“…24,25,26 One sixty seven (75.91%) of patients who developed clinical response had Grade 3 at the time of diagnosis which are matched with some studies where it was found that the better responses could be achieved in rapidly proliferating tumors with a higher grade. [27][28][29] One fifty two patients (69.09%) were found estrogen receptor positive tumor which are very near to results reported by Raina et al that was approximately 50.5% and studied upon the Indian patients. 26 Redkar et al reported 43.9% estrogen receptor positivity in 1992.…”

Neo-adjuvant chemotherapy and the recurrence of breast cancer in a tertiary care rural hospital of West Bengal, India

“…10 Hung WK et al, Stuart A McIntosh et al Poole GV et al also showed the same response in their studies. [23][24][25] All the 16 LABC patients who had recurrence in the present study received full course of NACT treatment and achieved complete pathological response after it. Nevertheless their average recurrence free survival was 2.8 years.…”

Locally Advanced Breast Cancer in Jamaica: Prevalence, Disease Characteristics and Response to Preoperative Therapy

“…These tumours are typically large and may extend beyond the breast tissue into the surrounding skin, muscle or chest wall, with clinical involvement of ipsilateral lymph nodes (axillary, internal mammary, supraclavicular or infraclavicular). In North America, around 5-10% of women newly diagnosed with breast cancer will have LABC (Newman, 2004;Kaufmann, 2006). Based on data from the large-scale, population-based Surveillance, Epidemiology and End Results database from the United States, LABC comprised 5.9% of all female breast carcinomas .…”