LOCALLY ADVANCED BREAST-CANCER - IS SURGERY WARRANTED FOLLOWING CHEMOTHERAPY

Various methods of management of locally advanced breast cancer have b een proposed, including combinations of chemotherapy, surgery, radioth erapy, immunotherapy and hormone manipulation. This retrospective stud y evaluated the effectiveness of chemotherapy in the management of loc ally advanced breast cancer in pre- and perimenopausal women by examin ing the pathology of the mastectomy specimens. Sixteen women who on in itial clinical examination had breast cancers measuring 5 cm or greate r underwent chemotherapy prior to surgery. Four women were also treate d with radiotherapy prior to surgery. All 16 women underwent mastectom y and axillary clearance. All specimens showed residual tumour in the mastectomy specimen or the regional lymph nodes. Chemotherapy is usefu l in reducing tumour burden to allow surgical resection, but does not produce centripetal shrinkage of tumour, nor sterilize the breast of c ancer. In this small series, the addition of radiotherapy also failed to clear the patient of tumour. Wide surgical excision including the o riginal tumour margins is thus required to achieve locoregional contro l. Until chemotherapy and radiotherapy regimens can be proved to steri lize the breast of tumour, we caution against the use of any surgery l ess than total mastectomy if optimal local control is to be achieved f or locally advanced breast cancer in pre- and perimenopausal women.