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LOCALLY ADVANCED BREAST CANCER. Elshami M.Elamin, MD Medical Oncologist Central Care Cancer Center www.cccancer.com Wichita, KS - USA. IIIA: T0-3, N2 T3, N1 (operable = not included) IIIB: T4 , any N0-2 IIICN3 Any T, N3. Inoperable Locally advanced-Non inflammatory.

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locally advanced breast cancer

LOCALLY ADVANCED BREAST CANCER

Elshami M.Elamin, MD

Medical Oncologist

Central Care Cancer Center

www.cccancer.com

Wichita, KS - USA

inoperable locally advanced non inflammatory

IIIA:

    • T0-3, N2
    • T3, N1 (operable = not included)
  • IIIB:
    • T4 , any N0-2
    • IIICN3
        • Any T, N3
Inoperable Locally advanced-Non inflammatory
inoperable locally advanced non inflamatory stage iiia t0 3n2 iiib c

1- Preop chemo/hormone (anthrac+/-Taxane preferred)

    • Any adj regimen or
    • A.I. for postmenopausal or
    • Trastuzumab-based for at least 9wk for her2-neu +ve

2- According to preop chemo response:

  • Response:
    • Mastectomy + LND + RT or
    • Consider lumpectomy + LND + RT
      • Xeloda as radiosensitizer
  • No response:
    • Additional chemo and/or RT

3- Adj therapy may include:

  • Chemo if not completed preoperatively
  • Trastuzumab
  • Hormonal therapy
Inoperable locally advancedNon-inflamatoryStage IIIA (T0-3N2), IIIB-C
inflammatory disease

CLINICAL:

    • T4d
        • Triad erythema
          • Skin erythema affecting > 1/3 of breast
          • Diffuse breast warmth
          • Skin edema and ridging (peau d’orange) caused by engorged dermal lymph
    • Nipple retraction
    • Adenopathy is common
    • 35% presents with mets
    • May mimic Cellulitis and Mastitis
  • PATHOLOGIC:
    • Dermal lymphatic involvement
      • 70% of clinically inflammatory carcinoma
  • Do you need both for diagnosis?
INFLAMMATORY DISEASE
grave signs

Grave signs Local recurr 5Y DFS

  • Skin edema 32% 23%
  • Skin ulceration 14% 36%
  • Fix to chest wall 40% 5%
  • > 2.5 cm axillary LN 13% 38%
  • Fixed axillary nodes 13% 13%

Haagensen Ann Surg: 1943

Grave signs
multimodality therapy

Surgery + RT:

      • 5YS <5%
  • Chemotherapy  MRM/RT
      • 5Y DFS 25-30%
      • 5Y S > 40%
        • Response to chemo is an important predictor of survival
  • ? ?? High-dose chemo with ABMT
  • ? Breast conservation
    • only in clinical trial
Multimodality Therapy
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