Preoperative systemic therapy in locally advanced breast cancer: A single institution experience

Background: Locally advanced breast cancer (LABC) is common in developing countries and it frequently affects younger women. Patients do very poorly when treated by locoregional therapy alone; therefore, preoperative systemic therapy (PST) is commonly used. Materials and Methods: Medical records of 64 Saudi patients with LABC treated with PST in a single institution were retrospectively reviewed. Results: At diagnosis, most patients were young (median age 41 years), and had poor clinicopathological characteristics. Following surgery, complete pathologic response (pCR) in the breast was achieved in 13 patients (20%). Of 62 patients with known nodal status, 22 (34%) had negative axillary nodes. Presence of estrogen receptor (ER) negative tumour was the only dependent variable that predicted pCR in the breast (P = 0.03). At a median follow-up of 42 months, the median progression-free survival (PFS) was 48 months (95% CI, 20-76 months) and the projected 5-year overall survival (OS) was 68%. The recently published scoring system (J Clin Oncol. 2008 Jan 10;26(2):246-52), was the only variable that independently influenced PFS, while ER negative tumours and presence of lymphovascular space invasion were the only factors that adversely affected OS. Conclusions: Despite the use of standard multimodality approach in the management of patients with LABC, prognosis remains guarded.