title: Breast conservation treatment in women with locally advanced breast cancer - experience from a single centre.
abstract: BACKGROUND
  In absence of randomized evidence to support safety of conservative surgery (BCT) in locally advanced breast cancer (LABC), we analyzed a cohort of 664 women with LABC treated during January 1998 to December 2002 at Tata Memorial Hospital, Mumbai, India.
  
  
  METHODS
  All were treated with a multimodality regimen comprising of neoadjuvant chemotherapy (NACT) followed by surgery (modified radical mastectomy or BCT) and adjuvant radiotherapy and hormone therapy. The outcome was evaluated to assess safety of BCT.
  
  
  RESULTS
  71% (469/664) women responded to NACT (22% clinical CR and 49% PR) and 28.3% (188/664) underwent BCT. Positive lumpectomy margins were reported in 8.5%, with gross presence of tumor at the margins in 2.3% requiring a revision surgery. At a median follow-up of 30months, local relapse rate was 8% after BCT and 10.7% after mastectomy. The 3-year local DFS was better post-conservation than after mastectomy (87% vs 78%, P=0.02). The disease-free survival (DFS) was also superior after BCT, 72% vs 52% (P<0.001) at 3years and 62% vs 37% (P<0.001) at 5years respectively. On multivariate analysis, presence of lymphatic vascular emboli (LVE) was the major significant predictor of local recurrence (P<0.001, HR 2.52, 95% CI 1.52-4.18). DFS was better after BCT [(P<0.001, HR 2.0 (95% CI 1.38-2.91)]; shorter DFS was noted in LVE positive (HR 1.54, P=0.007) and larger residual disease after NACT (HR 1.13, P=0.001).
  
  
  CONCLUSIONS
  BCT is technically feasible and safe post neo-adjuvant chemotherapy in women with LABC with no detriment in outcome.
authors.affiliation: Breast Service, Breast Group, Tata Memorial Hospital, Surgical Oncology, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra 400 012, India. vparmar@vsnl.net
authors.forename: V
authors.initials: V
authors.lastname: Parmar
authors.forename: A
authors.initials: A
authors.lastname: Krishnamurthy
authors.forename: R
authors.initials: R
authors.lastname: Hawaldar
authors.forename: M S
authors.initials: MS
authors.lastname: Nadkarni
authors.forename: R
authors.initials: R
authors.lastname: Sarin
authors.forename: R
authors.initials: R
authors.lastname: Chinoy
authors.forename: R
authors.initials: R
authors.lastname: Nair
authors.forename: K A
authors.initials: KA
authors.lastname: Dinshaw
authors.forename: R A
authors.initials: RA
authors.lastname: Badwe