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 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) 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) 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