Clinical presentation and management of locally advanced breast carcinoma

Abstract

Background: Locally advanced breast cancer (LABC) encompasses a heterogeneous collection of breast neoplasia with widely different clinical and biological characteristics. Multidisciplinary therapy has become the treatment of choice for these patients. The present study was undertaken to study the clinical presentation and effects of various modes of management of LABC.Methods: Total 45 patients presented with stage III and inflammatory carcinoma of breast were included in the study and treated with neoadjuvant chemotherapy, followed by surgery and radiotherapy. Clinical and pathological responses to different chemotherapy regimens were assessed according to World Health Organization criteria. Results: Majority of patients were in stage IIIA (55.6%) followed by stage IIIB (37.7%). Lump was most common symptom in all the cases followed by distortion of nipple (35.5%). After neoadjuvant chemotherapy, 70% of cases had clinical partial response and 25% of cases had clinical complete response and all except one case were converted from inoperable to operable cases. Histopathology was found to be infiltrating ductal carcinoma in 91.1% of cases. Flap necrosis (27.2%) and seroma (15.9%) was major complications of surgery while alopecia (88.8%), anemia (62.2%) were major complications of chemotherapy. Follow up data suggested that 77.7% patients doing well. One patient had expired after developing distant metastasis and 20% patients were lost to follow up.Conclusions: Treatment of LABC is multimodal and neoadjuvant chemotherapy converts inoperable cases to operable cases and improves longevity of life of the patient. The results of inflammatory carcinoma remain to be dismal in spite of multimodality treatment.