The Role of Surgery in

Locally Advanced Breast

Cancer
Djoko Handojo
Sub Bagian HNB Onkologi
Bagian / SM Bedah
FK UNDIP / RS Dr. Kariadi Semarang

Locally Advanced Breast

Cancer
O Most advanced-stage nonmetastatic breast tumors,

includes a wide variety of clinical scenarios

O Remain a difficult clinical problem as it relapses
and causes death
O Criteria of LABC : (MD anderson Cancer Center)
O Tumors > 5 cms
O Involves the skin or chest wall
O Fixed axillary lymph nodes, ipsilateral supraclavicular,

infraclavicular and internal mammary nodes

O All stages III disease (subset of stage IIB (T3N0))

O LABC from National Cancer Institutes

SEER
O 7% from all breast tumours patients
O Less than 5% from all breast cancer

patients who receive regular screening

mammography
O Survival Rates
O 3 year survival rates 70%
O 5 year survival rates 55%

O Median survival rates is 4,9 years

Chemotherapy Management of
LABC

O Chemosensitivity responses to

anticancer agents vary depending to

individual breast cancer patients
O The molecular subtype is inconclusive to
choose the effective chemotherapeutic
agents and more useful for planning
chemotherapy
O Triple Negative Breast Cancer (TNBC)
showed relatively more sensitive for
chemotherapy
O HER2/Neu overexpression is known to
predict poor outcome for chemotherapy

Operative Management of
LABC
O The magnitude of clinical response to

neoadjuvant chemotherapy in LABC

breast conservation in selected patients
O Several criteria for BCT in post neoadjuvant
chemotherapy :
O Patient desire for breast preservation
O Absence of multicentric disease
O Absence of diffuse microcalcifications on

mammogram
O Absence of skin involvement
O Residual tumor mass amenable to a margin-negative
lumpectomy resection

Ny. S idc gr2 ms T4cN2aMo

post kt neo adj

Ny. T - idc gr3 md T4bN2Mo

post kt neo adj

Ny. M - idc gr2 ms T4bN1Mo

Inflammatory Breast Cancer

A distinct clinical subtype of LABC

O Has aggresive behaviour and poor

prognosis
O Researchs show the overexpression
of RhoC GTPase and lost of LIBC
Protein highly correlated with IBC
O Clinically :
O Rapid onset of breast erythema
O Warmth and swelling
O Significant tenderness

O Optimal treatment of IBC requires

multimodal therapy
O Initial treatment induction
chemotherapy using anthracyclinebased regimen or anthracycline-taxane
combination

O Definitive local therapy can be

achieved radiation therapy,

mastectomy or both
Patient who respond well to chemotherapy are the best
candidate for surgery
If response to chemotherapy is poor, radiotherapy
should be undertaken before attempting surgery
O Breast conserving surgery and

sentinel lymph node biopsy are not

appropriate for patient with IBC
O Only one-third woman with IBC are
cured

Appreciate for the patience

and kind attention

THANK YOU