Locoregional Therapy of Locally Advanced Breast Cancer

Patient Population

Female patients with locally advanced breast cancer (LABC).

For purposes of this guideline, LABC includes Stages IIB and IIIABC and inflammatory cancer, as defined in the AJCC Cancer Staging Manual, 6th edition. Most studies in the evidentiary base (see Section 2) included heterogeneous populations spanning Stages IIB – IIIC and sometimes included inflammatory breast cancer. Very few studies dealt only with Stage III or specific subgroups such as patients with T3N0 cancer. As most of the major studies did not report results separately for patients with Stage IIB and Stage III cancers, the evidence did not support recommendations based on a narrower definition of LABC or subdivided by stage. Although some people do not consider Stage IIB to be locally advanced, there is an increasing trend to treat less bulky disease (Stage IIB) in a similar manner, including neoadjuvant therapy; therefore, the recommendations may also be applicable to this group.

Intended Guideline Users

Surgeons, and medical and radiation oncologists specializing in breast cancer.

Research Question(s)

1. In female patients with locally advanced breast cancer with good response to neoadjuvant therapy, what is the role of breast-conserving surgery (BCS) compared with mastectomy?
2. a. In female patients with locally advanced breast cancer who have had a mastectomy is radiotherapy indicated?
   b. In female patients with locally advanced breast cancer does locoregional irradiation result in higher survival and lower recurrence rates compared with breast/chest wall irradiation alone?
   c. In female patients with locally advanced breast cancer and pathologically complete response to neoadjuvant therapy is radiotherapy indicated?
3. In female patients with locally advanced breast cancer who receive neoadjuvant chemotherapy is sentinel lymph node biopsy (SLNB) or axillary dissection the most appropriate axillary staging procedure? Is SLNB indicated before neoadjuvant chemotherapy rather than at the time of surgery?
4. How should female patients with locally advanced breast cancer who do not respond to initial neoadjuvant therapy be treated?