Preoperative multimodal therapy for locally advanced non-inflammatory breast cancer

The present study is a comparison of two sequential groups of advanced locoregional (T3, T4) non-inflammatory breast cancers. The first group was of 164 cases treated between 1965 and 1975 who received radiotherapy followed by surgery (Group I). The second group was of 211 cases treated between 1976 and 1984, who received radiotherapy combined with multidrug chemotherapy followed by surgery (Group II). The 5 and 10 year disease-free survival in the two groups are 47.5% vs 60.6% (P less than 0.005) and at 10 years 35.9% vs 44.1% respectively (P less than 0.005). Tumour sterility in the resected breast was more than doubled in the chemotherapy group (18.9% vs 42.1%). The impact of the addition of chemotherapy on survival was seen only in the node-positive group, the 5-year disease-free survival in node-positive cases being 44.7% compared to 28.2% when chemotherapy was not used (P less than 0.007). Remote metastases at 5 years in node positive cases also showed a significantly lower rate in the CT + RT arm against the RT-only arm (36.4% vs 54.3%) (P less than 0.005). The results clearly demonstrate the advantage of a multimodality approach in the management of Stage III breast cancers.