Radiation Oncology/Breast/Advanced breast


 * For now, this page is for discussion of locally advanced breast cancer (LABC), defined as surgically unresectable at presentation.
 * Historically this includes features such as skin ulceration, tumor fixation to chest wall, satellite nodules, and palpable supraclavicular LNs
 * Today, it may also include operable tumors >5cm, which are typically treated with neoadjuvant chemotherapy
 * Inflammatory breast cancer is discussed separately at its own page.


 * MD Anderson
 * 2007 PMID 17418973 -- "Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy." (McGuire SE, Int J Radiat Oncol Biol Phys. 2007 Apr 5; [Epub ahead of print])
 * Retrospective. 106 LABC patients treated with neoadjuvant chemo, who achieved pCR on mastectomy. No inflammatory. Chemo 92% anthracycline-based, 38% also taxane. Post-mastectomy RT in 72 (68%). Median F/U 5.2 years
 * 10-year loco-regional recurrence: Stage I-II 0% for both with and without RT; Stage III RT 7.3% vs. no RT 33% (SS). In Stage III, also benefit to DSS and OS
 * Conclusion: PMRT provides significant clinical benefit for Stage III patients with pCR after neoadjuvant chemo and mastectomy
 * 2006 (1985-1989) PMID 16750325 -- "Fifteen-year results of a randomized prospective trial of hyperfractionated chest wall irradiation versus once-daily chest wall irradiation after chemotherapy and mastectomy for patients with locally advanced noninflammatory breast cancer." (Buchholz TA, Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1155-60.)
 * Phase III. 200 patients with clinical Stage III, no inflammatory BCA. Treated with neoadjuvant chemo; if CR then mastectomy and randomized to standard PMRT (60/30) vs. hyperfractionated PMRT (72/60 in 1.2 Gy BID). SCV treated in both arms to 50/25. Median F/U 15 years
 * 15-year LRR: standard 7% vs. hyperfractionated 12% (NS)
 * Toxicity: acute similar, moist desquammation standard 28% vs. hyperfractionated 42% (NS); late similar 6% vs. 11% (NS)
 * Conclusion: No evidence of clinical advantage for hyperfractionated regimen


 * NCI, 2004 (1980-1988) PMID 15483018 -- "Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy." (Low JA, J Clin Oncol. 2004 Oct 15;22(20):4067-74.)
 * Retrospective. 107 patients with Stage III BCA (46 inflammatory) prospectively treated on protocol. Initial chemo (CAFM), if pCR then PMRT concurrent with CAF chemo and conjugated hormones; if pPR then mastectomy/ALND and PMRT concurrent with CAF chemo and conjugated hormones. Median F/U 16.8 years
 * Median OS: inflammatory 3.8 years vs. IIIA 12.2 years vs. IIIB 9.0 years; 15-year OS: 20% vs. 50% vs. 23%
 * Pathologic CR not associated with improved survival