Purpose: The purpose of this analysis was to assess the
tumor response and long-term outcome in patients treated
with preoperative radiotherapy (PRT) without systemic
therapy.
Methods: Between 1997 and 2000, 134 patients with
non-inflammatory locally advanced breast cancer (LABC)
were treated with PRT. The tumor dose was 45 Gy in 15
fractions to the breast and to regional lymph nodes over
6 weeks. Radical mastectomy was performed 6 weeks after
PRT to all patients and adjuvant systemic therapy was
administered as per protocol. The measures of disease outcome
were overall survival (OS) and disease-free survival
(DFS) which estimated using the Kaplan-Meier method.
Results: Median follow-up was 74 months (range 4-216).
Objective clinical tumor response after PRT was observed
in 77.6% of the patients. Clinical complete tumor response
(cCR) was achieved in 21.6% of the patients. Pathological
CR in the breast was achieved in 15% of the patients. The
5- and 10-year OS were 55.1 and 37.8%, respectively. The 5-
and 10-year DFS were 39.2 and 27%, respectively. Patients
who achieved cCR had significantly longer OS in comparison
with patients achieving clinical partial response (cPR)
and clinical stable disease (cSD). Similarly, DFS of patients
in the cCR group was longer compared with patients with
cPR and cSD, yet without statistical significance.
Conclusions: Our results showed that local control in
LABC patients achieved by primary PRT, followed by radical
mastectomy was comparable with the results reported in
the literature. Complete pathologic response to PRT identified
a subgroup of patients with a trend toward better DFS
and OS