Experience with Adjuvant Therapy in 117 Patients with Locally Advanced Breast Cancer

BACKGROUND–Loco-regional recurrence and distant metastases are frequently disturbing events in patients with locally advanced breast cancer. This study was carried out to evaluate the role of postmastectomy conventional adjuvant treatment in such patients.MATERIALS AND METHODS–During the last five years, a total of 117 patients with locally advanced breast cancer (T3-T4 and/or more than four involved lymph nodes and/or fixed lymph nodes) were treated with postoperative chemotherapy and radiotherapy. Departmental records of these patients including stage, histology, sex, age, and therapeutic modalities were reviewed to assess the result of treatment. The cases with proven metastasis or T1-T2N0 lesions were excluded. The patients were divided into three groups. Arm I included T3-4N0, Arm II as a large primary tumor (T3-4) with 1 to 4 positive axillary nodes, and patients with more than 4 involved or fixed axillary lymph nodes, were considered as Arm III. We compared the result of adjuvant treatment in these groups.RESULTS–After a 7-year follow-up, loco-regional recurrence was seen in 13 (11.1%) patients and distant metastasis in 67 (57.2%) patients. The median event-free survival was 28 months in all patients. The median event-free survival was 78 months in patients with negative axillary nodes, 28 months in patients with one to four positive nodes, and 20 months in those with more than four positive or fixed axillary nodes. The difference in event-free survival between 3 groups was statistically significant (p = 0.026).CONCULSION–With conventional, local, and systemic treatment, a marked difference in local and distant failure exists between breast cancer patients with a T3-T4 N0 tumor and patients with positive axillary nodes