Management of non-inflammatory locally advanced breast cancer: focus on surgical approaches

Abstract

In non-inflammatory locally advanced breast cancer, treatment typically includes neoadjuvant chemotherapy, surgery, and radiation therapy. Neoadjuvant chemotherapy allows in vivo assessment of primary tumor response to chemotherapy and is achieved the early control of micrometastatic disease. It also significantly improves surgical outcomes. Patients achieving pathologic complete response after neoadjuvant chemotherapy have a better survival. Tumor downsizing can make breast conserving therapy by ­allowing for smaller resections and improving cosmesis. Tumor downstaging with chemotherapy can allow breast conserving surgery in patients who are initially candidate for mastectomy. Sentinel lymph node biopsy is an appropriate alternative to routine staging axillary dissection for early-stage breast cancer patients with clinically negative axillary nodes. During the last years there have been a number of clinical studies on effectiveness and role of sentinel lymph node biopsy in patients receiving neoadjuvant chemotherapy. The use of sentinel lymph node biopsy is an alternative approach to axillary dissection in patients with neoadjuvant the­rapy. In conclusion, patients with locally advanced breast cancer are treated with neoadjuvant chemotherapy followed by breast conser­ving surgery with axillary dissection and radiation therapy as a part of the multimodality management.