title: Pre-operative systemic therapy in locally advanced breast cancer: a single institution experience.
abstract: BACKGROUND
  Locally advanced breast cancer (LABC) is common in developing countries and it frequently affects younger women. Patients do very poorly when treated by locoregional therapy alone; therefore, pre-operative systemic therapy (PST) is commonly used.
  
  
  METHODS
  Medical records of 64 Saudi patients with LABC treated with PST in a single institution were retrospectively reviewed.
  
  
  RESULTS
  At diagnosis, most patients were young (median age 41 years), and had poor clinicopathological characteristics. Following surgery, complete pathologic response (pCR) in the breast was achieved in 13 patients (20%). Of 62 patients with known nodal status, 22 (34%) had negative axillary nodes. Presence of oestrogen receptor (ER) negative tumour was the only dependent variable that predicted pCR in the breast (p = 0.03). At a median follow-up of 42 months, the median progression-free survival (PFS) was 48 months (95% CI, 20-76 months) and the projected five-year overall survival (OS) was 68%. The recently published scoring system (Jeruss et al (2008) J Clin Oncol26 2 246-52), was the only variable that independently influenced PFS, while ER negative tumours and presence of lymphovascular space invasion were the only factors that adversely affected OS.
  
  
  CONCLUSIONS
  despite the use of standard multi-modality approach in the management of patients with LABC, prognosis remains guarded.
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah 21499, Kingdom of Saudi Arabia.
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authors.lastname: Ibrahim
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authors.lastname: Al-Ahmadi
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