title: Concurrent chemoradiotherapy for locally advanced breast cancer-time for a new paradigm?
abstract: BACKGROUND
  In cases of locally advanced breast cancer (labc), preoperative ("neoadjuvant") therapy was traditionally reserved to render the patient operable. More recently, neoadjuvant therapy, particularly chemotherapy, is being used in patients with operable disease to increase the opportunity for breast conservation. Despite the increasing use of preoperative chemotherapy, rates of pathologic complete response, a surrogate marker for disease-free survival, remain modest in patients with locally advanced disease and particularly so when the tumour is estrogen or progesterone receptor-positive and her2-negative. A new paradigm for labc patients is needed. In other solid tumours (for example, rectal, esophageal, and lung cancers), concurrent chemoradiotherapy (ccrt) is routinely used in neoadjuvant and adjuvant treatment protocols alike.
  
  
  RESULTS
  The literature suggests that ccrt in labc patients with inoperable disease is associated with response rates higher than would be anticipated with systemic therapy alone.
  
  
  CONCLUSIONS
  Ongoing trials in this field are eagerly awaited to determine if ccrt should become the new paradigm.
authors: Department of Medical Oncology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC.
authors: V
authors: V
authors: Mandilaras
authors: Department of Medical Oncology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC.
authors: N
authors: N
authors: Bouganim
authors: Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON.
authors: J
authors: J
authors: Spayne
authors: Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON.
authors: R
authors: R
authors: Dent
authors: Ottawa Hospital Cancer Centre and Ottawa Hospital Research Institute, Ottawa, ON.
authors: A
authors: A
authors: Arnaout
authors: Department of Oncology, Jewish General Hospital and Segal Cancer Centre, Montreal, QC.
authors: J F
authors: JF
authors: Boileau
authors: London Regional Cancer Program, Division of General Surgery/Surgical Oncology, London, ON.
authors: M
authors: M
authors: Brackstone
authors: Department of Surgical Oncology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC.
authors: S
authors: S
authors: Meterissian
authors: Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON.
authors: M
authors: M
authors: Clemons
keywords: Breast cancer; concurrent chemoradiotherapy; locally advanced disease; neoadjuvant therapy