How is stage III breast cancer treated?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

Considerations are as follows:

  • Patients with stage III disease are divided into those who are candidates for operative treatment and those who are not

  • Patients with stage IIIA breast cancer are further divided into those with T3N1M0 disease and those with TanyN2M0 disease; for treatment of patients with operable T3N1M0 disease, see Treatment recommendations for localized disease, above

  • Therapeutic options for locally advanced disease are similar to those for localized disease but include consideration of preoperative (neoadjuvant) chemotherapy followed by local surgical therapy

  • In general, all planned chemotherapy should be given preoperatively to optimize the potential for inducing a pathologic complete response (pCR), which has been shown to be associated with improved outcomes (90% of higher disease-free survival [DFS] rates)

  • Preoperative systemic chemotherapy is indicated for all patients with inflammatory breast carcinoma, ipsilateral supraclavicular adenopathy, bulky axillary adenopathy, extension to the skin or chest wall, or a large (>5 cm) primary tumor; patients who do not meet these criteria but would benefit from tumor cytoreduction before surgery to facilitate breast conservation should be considered for such treatment

  • Radiopaque clips should be placed in the tumor bed before the start of preoperative therapy, and breast imaging should be repeated after therapy in any such patients for whom breast conservation is being considered

  • RT to the breast or chest wall is indicated for any patient who received preoperative systemic chemotherapy


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