MANAGEMENT OF LOCALLY ADVANCED-CARCINOMA OF THE BREAST .1. NONINFLAMMATORY

Background. The treatment of patients with locally advanced noninflamm atory breast cancer has evolved substantially over the past 30 years. From 1968 to 1989, 281 women were treated at Mallinckrodt Radiation On cology Center with four different treatment methods. Median follow-up was 6.2 years (range 3-22 years); no patient was lost to follow-up. Me thods. Retrospective review of records and analysis of data on a compu ter file were carried out. Thirty-five patients were treated with irra diation alone, 33 with irradiation and adjuvant chemotherapy, 81 with mastectomy and irradiation, and 132 with mastectomy, irradiation, and chemotherapy (triple-modality). Results. Actuarial 5- and 10-year dise ase free survival (DFS) rates were 45% and 36%, respectively, with tri ple-modality therapy, 31% and 10% with irradiation and chemotherapy, 3 2% and 19% with irradiation and mastectomy, and 19% and 11% with irrad iation alone. Cause specific survival (CSS) paralleled DFS in the four groups. Locoregional tumor control at 5 years was 91% for irradiation , mastectomy, and chemotherapy, 80% for irradiation and mastectomy, 54 % for irradiation and chemotherapy, and 31% for irradiation alone. Sys temic therapy and/or irradiation given before mastectomy yielded bette r locoregional tumor control, DFS, and CSS (not statistically signific ant). No difference in results was noted with radical, modified radica l, or total mastectomy. In the triple-modality group, no chest wall fa ilures occurred with chest wall doses greater than 5040 cGy. Grade 2 o f higher treatment sequelae were noted in 10-42% of patients, dependin g on treatment modality. Conclusions. Triple-modality therapy yielded improved locoregional tumor control, DFS, and CSS compared with other modalities. Patients treated with surgery had better locoregional tumo r control than those who received irradiation alone or in combination with chemotherapy, but the impact on DFS and CSS was less impressive. Additional clinical trials are needed to define further the role and o ptimal use of the various therapeutic modalities in the management of locally advanced breast cancer.