Surgery for T4 breast carcinoma: Implications for local control

Despite increasing public awareness and widespread availability of mammogra phy, many patients will present with locally advanced breast cancers. The r ole of surgery remains controversial. Between 1993 and 1998, 47 of 393 (11. 9%) breast cancer patients presented with T4 (inflammatory or locally advan ced) carcinoma. We reviewed multimodality management, clinical response to neoadjuvant therapy, perioperative course and complications, and local cont rol. Forty-six women and one man were diagnosed with clinical T4 breast can cer. There were 24 white and 23 African-American patients. Mean age at pres entation was 54.5 (range, 31-88) years. Twenty-three patients had clinical metastases to axillary nodes, and five had distant metastases at the time o f diagnosis. For these women, intent was for personal hygiene and control o f pain. Neoadjuvant chemotherapy was given for 34 of 47 (72%) with 25 of 34 (73.5%) having partial or complete clinical response. There was no respons e or progression of disease in 9 of 34(26.5%). Forty-six patients underwent radical or modified radical mastectomy, whereas a single patient underwent breast conservation treatment. Twelve required tissue transfer for wound c overage. Although eight developed minor wound complications (cellulitis/fla p separation), there were no major wound complications. Pathologically nega tive margins were achieved in all but one patient. To date, five women have developed local recurrence in either the chest wall (three) or axilla (two ). Average time to local recurrence was 7.8 months. There is no evidence of local failure in the remaining 87 per cent. Locally advanced breast cancer is a common occurrence in certain populations. Multimodality management re mains the standard of care. Surgical resection may allow for successful loc al control and, in certain situations, long-term cure.