title: Is there a role for salvage radiotherapy in locally advanced breast cancer refractory to neoadjuvant chemotherapy?
abstract: BACKGROUND
  Locally advanced breast cancer (LABC) is a major problem, especially in developing countries. The standard treatment for LABC is neoadjuvant chemotherapy, with or without anti-Her2 therapy, followed by surgery, radiotherapy, and adjuvant systemic treatment if appropriate. However, there are few data in the literature addressing alternatives when neoadjuvant chemotherapy fails to reduce the tumour for surgery.
  
  
  METHODS
  We conducted a retrospective study including all patients who had non-metastatic LABC treated with neoadjuvant chemotherapy and who were not eligible for surgical resection; these patients were submitted to salvage radiotherapy (RTX) between January 2000 and December 2012 at the Brazilian National Cancer Institute.
  
  
  RESULTS
  Fifty-seven patients were included, with a median age of 51 (23-72) years. The most frequent clinical stages were IIIA and IIIB, corresponding to 19.3% and 70.2%, respectively; mean tumour size was 8.74 (3-18) cm, and 44 patients (77.2%) had nodal involvement. Chemotherapeutic regimens containing anthracyclines were prescribed to 98.2% of the patients. Fifteen patients (26.3%) received taxanes and anthracyclines. Radiation dose was 50 Gy divided into 25 fractions; 43 patients (75.4%) had their tumours downsized by RTX and underwent mastectomy. Overall survival (OS) was 38 (23-52) months. Patients who were submitted to surgery had an OS of 49 (28-70) months and those who were not eligible for mastectomy after radiotherapy had an OS of 18 (9-27) months.
  
  
  CONCLUSIONS
  This retrospective study confirms that RTX is an effective treatment to downsize LABC tumours with low or no response to chemotherapy, thereby enabling surgical resection which may improve overall patient outcome.
authors.affiliation: Department of Clinical Oncology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil. Electronic address: rccmed@gmail.com.
authors.forename: R C
authors.initials: RC
authors.lastname: Coelho
authors.affiliation: Department of Clinical Oncology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
authors.forename: F M L
authors.initials: FML
authors.lastname: Da Silva
authors.affiliation: Department of Clinical Oncology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
authors.forename: I M L
authors.initials: IML
authors.lastname: Do Carmo
authors.affiliation: Department of Clinical Oncology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
authors.forename: B V
authors.initials: BV
authors.lastname: Bonaccorsi
authors.affiliation: Department of Clinical Oncology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
authors.forename: S M
authors.initials: SM
authors.lastname: Hahn
authors.affiliation: Department of Clinical Oncology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
authors.forename: L D
authors.initials: LD
authors.lastname: Faroni
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000628:therapy; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000556:secondary / Q000628:therapy; D018275:Carcinoma, Lobular / Q000532:radiotherapy* / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane
keywords: Breast cancer; Locally advanced; Neoadjuvant chemotherapy; Radiotherapy; Retrospective study