Impact of clinical, pathologic, and treatment-related factors on outcome in patients with locally advanced breast cancer treated with multimodality therapy

The authors reviewed the experience at their institution treating patients with locally advanced breast cancer using multimodality therapy to identify clinical, pathologic, and treatment-related factors affecting outcome. One hundred patients with locally advanced breast cancer were treated with def initive therapy at William Beaumont Hospital. Three patients had stage IIB disease, 45 patients had stage IIIA disease, and 52 patients had IIIB disea se. Thirteen patients had inflammatory breast carcinoma. Seventy-four patie nts (74%) received trimodality therapy consisting of systemic therapy, radi ation therapy, and surgery. Systemic therapy was delivered to 90 patients. Eighty-three patients (83%) received adjuvant radiation therapy. Eighty-fiv e patients underwent mastectomy (85%). Multiple clinical, pathologic, and t reatment-related factors were analyzed for their impact on outcome. The med ian follow-up was 47 months. Overall, the 5-year actuarial rates of local c ontrol, disease-free survival, overall survival, and cause-specific surviva l were 81%, 43%, 53%, and 55%, respectively. The 5-year actuarial cause-spe cific survival rates for patients with inflammatory breast carcinoma, stage IIIA disease, and stage IIIB disease were 25%, 55%, and 53%, respectively. On multivariate analysis, local control was improved with radiation therap y (p = 0.008) and the absence of inflammatory breast carcinoma (p = 0.008). Disease-free survival was improved with the addition of radiation therapy (p = 0.001) and with less than four positive lymph nodes (p = 0.003). Dista nt metastasis-free survival was improved in patients without inflammatory b reast carcinoma (p = 0.0249) and with less than four involved lymph nodes ( p = 0.0135). Cause-specific survival and overall survival were adversely af fected by the presence of inflammatory breast carcinoma (p = 0.0135 and p = 0.0325, respectively) or four or more involved lymph nodes (p = 0.0082 and p = 0.012, respectively). Radiation therapy appears to be a critical compo nent in the overall treatment of patients with locally advanced breast canc er by improving the rates of local control and disease-free survival. Other adverse factors for survival include four or more positive lymph nodes and inflammatory breast carcinoma.