PRIMARY CHEMOTHERAPY FOR EARLY AND ADVANCED BREAST-CANCER

While locally advanced breast cancer (LABC) represents a small fractio n of patients with breast cancer in industrialized nations, in develop ing countries it might constitute up to 50% of incident cases. The def inition includes patients with stage IIB, III, and some with limited s tage IV breast cancer. Inflammatory breast cancer (IBC) is part of LAB C, but it is often reported separately, because of its dismal prognosi s, LABC can be considered technically operable (stage II and IIIA), or inoperable (stage IIIB, IV and IBC), For the last two decades, patien ts with inoperable LABC and IBC have been treated with increasing freq uency with systemic therapy first, followed by regional therapy, eithe r surgical resection or radiotherapy, Most treatment programs also inc luded adjuvant systemic therapy, The majority of patients with LABC an d IBC respond to primary chemotherapy, and most can be rendered diseas e-free initially. Local control rates exceed 80% with modern combined- modality treatment strategies, Since most tumors are downstaged, some patients can be treated with breast-conserving treatments, The optimal sequence of local and systemic treatments has not been defined. Combi ned-modality therapies improve the treatment and the outcome for patie nts with LABC. Whether the sequence of utilization of various treatmen ts influences outcome remains to be established. The administration of systemic therapies first also provides a useful biological model to a ssess the effects of systemic treatments on the primary tumor and regi onal metastases, since these are available for serial non-invasive eva luation and sampling of tumor tissue.