ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

MANAGEMENT OF LOCALLY ADVANCED BREAST CANCER

Cihan Atar1 Ahmet Onur Demirel2

1Osmaniye State Hospital, Department of General Surgery, Osmaniye, Türkiye
2Kilis State Hospital, Department of General Surgery, Kilis, Türkiye

Atar C, Demirel AO. Management of Locally Advanced Breast Cancer. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.137-144.

ABSTRACT

Locally advanced breast cancer (LABC) is a heterogeneous group of diseases characterized by invasion of the primary tumor into adjacent anatomical structures and/or involvement of regional lymph nodes in the absence of distant metastasis. It includes cases that are not directly suitable for mastectomy or breast-conserving surgery and cannot be surgically resected without systemic or radiotherapeutic intervention. At diagnosis, LABC is often associated with a high risk of occult distant metastasis, and advanced imaging modalities such as CT and PET-CT are recommended for proper staging.The management of LABC necessitates a multidisciplinary approach involving systemic therapy, surgery, and radiotherapy. Neoadjuvant chemotherapy (NACT) is widely employed to downstage disease, increase resectability, and improve pathological complete response (pCR) rates, which correlate with enhanced overall and disease-free survival. Dual HER2 blockade and immunotherapy have notably improved pCR rates in HER2-positive and triple-negative breast cancer subtypes, respectively. In selected patients with hormone receptor-positive disease, neoadjuvant endocrine therapy may be equally effective. Surgical strategy should be based on tumour response to preoperative treatment. Advances in systemic therapies have broadened the feasibility of breast-conserving surgery, even in cases previously considered for mastectomy. Early breast reconstruction, including implant-based and autologous options, is increasingly common and safe. In axillary surgery, sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD) have emerged as preferable techniques over routine axillary lymph node dissection (ALND), reducing morbidity without compromising oncologic safety. PET-positive axillary nodes post-NACT require biopsy confirmation before proceeding with ALND to avoid overtreatment. Radiotherapy plays a role in both curative and palliative settings. Postoperative radiotherapy improves local control, particularly in patients with large tumours or positive surgical margins. In unresectable cases or when systemic therapy fails, palliative radiotherapy can relieve symptoms and enhance quality of life. In conclusion, LABC requires careful integration of multimodal treatment strategies. Optimal outcomes rely on accurate staging, personalised systemic therapies, tailored surgical approaches, and strategic radiotherapy application. Multidisciplinary coordination remains key to improving survival and quality of life for patients with LABC.

Keywords: Breast neoplasms; Radiotherapy; Neoadjuvant therapy; Breast-conserving surgery; Mastectomy

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