Abstract
Locally advanced breast cancer is a specific clinic entity, comprising various degrees of breast cancer local and regional extension. This term is applied to nonmetastatic large primary tumors (including inflammatory breast carcinoma), with or without extensive regional lymph node involvement, with a rapid or slow evolution, and usually with poor prognosis. This clinical presentation of mammary carcinoma is common in developing countries (30% to 60%), but also with a remarkable incidence in developed countries (10% to 20%). During many decades patients were treated with radical surgery or radiation therapy and with their combination, but always with poor results. The inclusion of neoadjuvant chemotherapy in the treatment enabled more favorable treatment results. The mortality from disseminated disease is the main problem in these patients, inducing the question of need for additional postoperative adjuvant systemic therapy. For steroid receptor positive patients hormonotherapy is a convenient choice of maintaining treatment. In endocrine non-responsive tumors, the role of postoperative chemotherapy is doubtful, having in mind preoperative chemotherapy and cumulative toxic effects. New trials including the large number of patients are necessary to obtain the definite answer whether the maintaining chemotherapy is useful but today it seems that additive postoperative treatment is not more efficient than preoperative alone.
Highlights
Advanced breast cancer (LABC), as a specific clinic entity, comprises various degrees of breast cancer local and regional extension
There is still a dilemma how optimally to treat each new patient, avoiding both undertreatment and overtreament. This is a result of the fact that Locally advanced breast cancer (LABC) is less common in industrialized countries, and the heterogeneity of this disease makes the performance of controlled trials more complex [1]
The patients with LABC have the signs of high risk for dissemination even at the presentation; as a result of that, the mortality from metastatic disease is the greatest problem in this group of patients
Summary
Advanced breast cancer (LABC), as a specific clinic entity, comprises various degrees of breast cancer local and regional extension. To put it this term is applied to nonmetastatic lesions of large size, usually with poor prognosis. Various clinical presentations are characterized by presence of a large primary tumor and/or extensive regional lymph node involvement, but always with the absence of any evidence of distant metastases. Patients can have T3 or T4 tumors with any N stage, or any T category with nodal involvement N2 or N3, and regional metastatic involvement (M1). Inflammatory breast carcinoma is included in LABC category [1,2]. The biological behavior of LABC can be very heterogeneous, with a rapid evolution, and with a long history of slow tumor growth [1]
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