SELECTION OF LOCAL THERAPY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTSWITH STAGE IIIA,B BREAST-CANCER

Background: Stage IIIA,B breast cancer is commonly treated with neoadj uvant chemotherapy because of high objective response rates and improv ed operability. Criteria for subsequent selection of local therapy-mas tectomy, radiotherapy, or both-are not well defined. We adopted a poli cy of selective local therapy based on rebiopsy of the breast and clin ical axillary lymph node status at the time of best response to chemot herapy. Methods: Between 1980 and 1993, 126 patients with stage IIIA,B breast cancer were treated with neoadjuvant chemotherapy and definiti ve local therapy. The long-term incidence of locoregional failure (in- breast, chest wall, axilla, supraclavicular, neck), relapse-free survi val, and overall survival was determined. Results: The overall clinica l objective response rate to chemotherapy was 95.2%. Eighty-three pati ents underwent mastectomy, with negative margins achieved in 91.6%. Fo rty-two patients had breast preservation; the overall in-breast recurr ence rate was 19.0% (8 of 42 patients). The overall locoregional recur rence rate by site was: chest wall-8.7% (11 of 126 patients), axilla-8 .7% (11 of 126 patients), supraclavicular-5.6% (7 of 126 patients), an d neck-4.0% (5 of 126 patients). The axillary recurrence rate was 6.6% (5 of 76 patients) for clinically negative axilla treated with radiot herapy only, and 12.0% (6 of 50 patients) for clinically positive axil la treated with surgery only. The overall long-term survival probabili ties (6 years) according to stage were: stage IIIA-58.0%, stage IIIBno ninflam-58.0%, stage IIIBinflam-36.0%. Conclusions: These findings sup port a selective approach to local therapy in patients with stage IIIA ,B boast cancer. This approach provides local control in most patients , and allows for breast preservation and elimination of axillary disse ction in selected patients.