Locally Advanced Breast Cancer

  • BBSG – Brazilian Breast Study Group


The 7th edition of the American Joint Committee on Cancer (AJCC) classifies a locally advanced breast cancer (LABC) as those included in III stadium (IIIA, IIIB, and IIIC) represented by tumors >5 cm (T3) or those associated with chest wall (T4A), skin (T4B), or both (T4c) involvement or the presence of fixed or matted axillary lymph nodes (N2/N3) of one or more lymphatic drainage chains (axillary, supraclavicular, or internal mammary) (T4D) (inflammatory carcinoma).


Breast-conserving surgery Mastectomy Sentinel node biopsy Neoadjuvant systemic treatment Radiation therapy 

Recommended Reading

  1. 1.
    Allemani C, Sant M, Richardson LC, Baili P, Storn H, Torrella-Ramos A, et al. Breast cancer survival in the US and Europe: a Concord high-resolution study. Int J Cancer. 2013;132(5):1170–81. A study supporting different incidences among the clinical stages of breast cancer in approximately 20,000 women in 7 American states and 12 European countries. It has been demonstrated that there is a higher incidence of locally advanced carcinomas in European countries when compared to the USA. CrossRefGoogle Scholar
  2. 2.
    Galimberti V, Ribeiro Fontana SK, Maisonneuve P, et al. Sentinel node biopsy after neoadjuvant treatment in breast cancer: five-year follow-up of patients with clinically node-negative or node-positive disease before treatment. EJSO. 2016;42:361–8. A retrospective study supporting that patients submitted to neo-adjuvant QT, that SLNB is feasible in the group with clinically positive axilla that presented complete clinical response. Overall 5-year survival was the same when compared to the group with previously negative axilla. Patients with positive axilla, who were negative on chemotherapy and submitted to sole SLNB, presented axillary recurrence smaller than 1% in 5 years. CrossRefGoogle Scholar
  3. 3.
    Lee MC, Joh JE, Chau A. Axillary staging prior to neoadjuvant chemotherapy: the roles of sentinel lymph node biopsy and axillary ultrasonography. Cancer Control. 2012;19(4):277–85. Axillary ultrasonography (with or without biopsy) and SLNB represent the safe and feasible staging and may be useful to plan surgical, radiotherapy, and chemotherapeutic approaches. The specificity and ability to detect impairment ranged from 70-96% and 50-73%, respectively. The specificity increased considerably with percutaneous SLN biopsies. CrossRefGoogle Scholar
  4. 4.
    Pilewskie M, Morrow M. Axillary nodal management following neoadjuvant chemotherapy: a review. JAMA Oncol. 2017;3(4):549–55. Review article encompassing the main studies on SLNB and neo-adjuvant chemotherapy. Explains the identification rates, false negative rates and limitations of prospective studies, emphasizing SENTINA trial, FNAC SF and ACOSOG 1071. In cases with previously positive axilla and complete biological response after neo-QT, supported acceptable rates of FN when excised 3 or more SLN and the marking is performed by radioisotope and patent blue dye CrossRefGoogle Scholar
  5. 5.
    Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, et al. Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and b 27. J Clin Oncol. 2008;26(6):778–85. NSABP protocols B18 and B27 supported that neo-adjuvant QT is equivalent to adjuvant. In Protocol B18, women <50 years of age, treated with neo-adjuvant QT presented higher SLD and SG, trending towards statistical significance. RH 0.85. p 0.09 w / SLD and 0.06 w / wG). At B 27, the addition of taxane to the AC plan considerably increased the achievement of complete biological response (RpC). (26.13%, p = 0.0001). In both studies, patients who achieved RpC continue to present better SLD and SG, compared to those who did not. CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • BBSG – Brazilian Breast Study Group
    • 1
  1. 1.BBSGSao PauloBrazil

Personalised recommendations