The management of locally advanced breast cancer

Assessment of the effect of pretreatment with neoadjuvant therapy on primary breast cancer

“…Secondly, the degree of reduction in size achieved by primary chemotherapy may well reflect the sensitivity of micrometastases to systemic chemotherapy and thus could be a highly significant prognostic feature in patients with breast cancer. This has confirmed the results of previous nonrandomised trials using chemotherapy alone (Hortobagyi et al, 1991) or with radiotherapy and endocrine therapy (Rubens et al, 1992). However, although 25 patients (25%) had a complete clinical resolution of their primary tumour, the radiological assessment showed an average mammographic reduction in size by 78% and on ultrasound by 85%.…”

Role for Sentinel Lymph Node Dissection in the Management of Large (≥5 cm) Invasive Breast Cancer

“…11,14 Regional nodal status will rarely alter neoadjuvant or adjuvant therapy decisions in this group because the majority will need systemic therapy solely on the basis of characteristics of the primary tumor. 1,5,6,15 However, axillary nodal status remains the single most important prognosticator in breast cancer, regardless of primary tumor size. 16 Because node-positive patients have a worse outcome, the tumor status of the regional lymph nodes can be used to stratify favorable and unfavorable prognostic groups.…”

“…1 Although neoadjuvant chemotherapy does not seem to improve the poorer prognosis of this group, [2][3][4] it can increase the rate of breast conservation and indicate a patient's clinical response to systemic therapy. 5 However, not infrequently a patient will refuse neoadjuvant chemotherapy unless the axillary lymph nodes have been shown to harbor metastatic tumor.…”

Combined modality treatment of locally advanced breast carcinoma in elderly patients or patients with severe comorbid conditions using tamoxifen as the primary therapy

“…1 For decades local therapies (such as surgery and/or radiotherapy) were the treatment of choice, but results were poor due to the high frequency of distant recurrence, 2 which is why combined modality treatments (including systemic chemotherapy and hormonal therapy) became the standard of care for these patients. [3][4][5] Recently, more emphasis also has been placed on breast conservation in patients with LABC. 6 Although patients age Ͼ 75 years have the highest incidence rates of breast carcinoma, 7 they usually are excluded from combined modality programs because of their high rate of incidence of comorbid conditions and the widespread belief that elderly patients cannot tolerate aggressive treatments.…”