The role of radiation therapy in locally advanced breast cancer

Purpose: To evaluate the impact of adjuvant radiotherapy (XRT) following neoadjuvant chemotherapy and surgery for noninflammatory locally advanced breast cancer(LABC). Methods and Materials: We retrieved database of 2663 patients from Cancer Registry of Slovenia treated between 1999 and 2004 with chemotherapy and surgery for breast cancer. A total of 64 patient received neoadjuvant chemotherapy and operation with or without XRT and hormonal therapy. We retrospectively analyzed the rates of locoregional failure (LRF), overall survival (OS) and disease-free survival (DFS) in these patients. Results: Median follow-up was 45 months. The patient's clinical stages at diagnosis were IIA 4.6%, IIB 17.2%, IIIA 51.6%, IIIB 21.9% and IIIC 4.7%. The 5-year OS and DFS rates were 75,5% and 56,1% respectively. Total LRF rate was 12.5%. In group of patients who received XRT LRF was 9% and 21% in group without XRT. In the later group all but one patient should have received XRT, if the decision was to be based on clinical rather than pathological tumor stage. In no XRT group LRF occurred in 4/9 grade III tumors, 1/5 pT0, 2/6 pT1, 1/6 pT2, 1/7 pN0 and 1/4 pN1. In patients who received XRT relapse occurred in 0/10 pT0, 1/9 pT1, 2/14 pT2, 1/11 pN0 and 1/7 pN1. Conclusion: Adjuvant XRT after neoadjuvant chemotherapy and surgery for LABC improves local control significantly. It should be based on clinical stage at diagnosis rather than pathological stage.