The role of radiation therapy in the management of locally advanced carcinoma of the breast

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Abstract
Current management of patients with locally advanced breast cancer is not satisfactory. Establishing local tumor control is a problem with either surgery or radiation therapy alone. There is some suggestion that the two modalities should be combined when possible. Regardless of local control, distant metastasis is quite common. An example of the results of primary radiation therapy for locally advanced breast cancer is described in the study from the Joint Center for Radiation Therapy where the actuarial rate of local control was 54% and the 5-year survival was 30%. Recently, adjuvant chemotherapy has been introduced in the management of these patients. The authors' studies indicate that adjuvant chemotherapy not only increases the 5-year survival, but also improves local tumor control. At this time it is unclear whether adjuvant chemotherapy has improved the cure rate or simply increased the time to treatment failure. Current studies are directed toward the optimum interfacing of local treatment and adjuvant chemotherapy. It is only through an aggressive approach to both the local disease as well as the subclinical distant metastases that an increased cure for patients with locally advanced breast cancer will be achieved.

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