Clinical practice guidelines for the care and of breast cancer: 15. Treatment for women with stage III or locally advanced breast cancer

Shenkier, Tamara; Weir, Lorna; Levine, Mark; Olivotto, Ivo; Whelan, Timothy; Reyno, Leonard
March 2004
CMAJ: Canadian Medical Association Journal;3/16/2004, Vol. 170 Issue 6, p983
Academic Journal
Objective: To define the optimal treatment for women with stage III or locally advanced breast cancer (LABC). Evidence: Systematic review of English-language literature retrieved from MEDLINE (1984 to June 2002) and CANCERLIT (1983 to June 2002). A nonsystematic review of the literature was continued through December 2003. Recommendations: • The management of LABC requires a combined modality treatment approach involving surgery, radiotherapy and systemic therapy. Systemic therapy: chemotherapy Operable tumours • Patients with operable stage IIIA disease should be offered chemotherapy. They should receive adjuvant chemotherapy following surgery, or primary chemotherapy followed by locoregional management. • Chemotherapy should contain an anthracycline. Acceptable regimens are 6 cycles of FAC, CAF, CEF or FEC. Taxanes are under intense investigation. Inoperable tumours • Patients with stage IIIB or IIIC disease, including those with inflammatory breast cancer and those with isolated ipsilateral internal mammary or supraclavicular lymph-node involvement, should be treated with primary anthracycline-based chemotherapy. • Acceptable chemotherapy regimens are FAC, CAF, CEF or FEC. Taxanes are under intense investigation. • Patients with stage IIIB or IIIC disease who respond to primary chemotherapy should be treated until the response plateaus or to a maximum of 6 cycles (minimum 4 cycles). Patients with stage IIIB disease should then undergo definitive surgery and irradiation. The locoregional management of patients with stage IIIC disease who respond to chemotherapy should be individualized. In patients with stage IIIB or IIIC disease who achieve maximum response with fewer than 6 cycles, further adjuvant chemotherapy can be given following surgery and irradiation. Patients whose tumours do not respond to primary chemotherapy can be treated with taxane chemotherapy or can proceed directly to irradiation followed by modified radical...


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