LOCALLY ADVANCED BREAST CANCER: AN EXPERIENCE IN MASHHAD, NORTH-EAST OF IRAN, 1995 – 1999

Background: Locally advanced breast cancer (LABC) remains a clinical challenge as the majority of patients with this diagnosis develop distant metastases despite appropriate therapy. Objective: To evaluate the treatment results of patients with locally advanced breast carcinoma who attended our hospital in Mashhad, North-East of Iran. Some presumed prognostic factors were also assessed. Methods: We retrospectively reviewed the medical records of 133 patients with LABC who were treated in Omid Hospital, affiliated to Mashhad University of Medical Sciences, between April 1995 and April 1999. One hundred and five patients with available follow-up information were selected for statistical analysis. Ninety-seven of 105 patients had undergone mastectomy prior to referral. Eight cases had received neoadjuvant chemotherapy. All patients were treated with adjuvant radiotherapy with 95 receiving adjuvant or neoadjuvant chemotherapy (40 CMF, 50 CAF, and 5 cases CAF sequential to CMF). We used the Kaplan-Meier survival analysis for evaluation of survival rates and the log-rank test to compare the survival profile between groups. Results: During a median follow-up period of 32 (range: 5 – 96) months, 47 (45%) of 105 patients experienced recurrence. The mean ± SEM 2- and 5-year overall survival rates were 80.4 ± 5% and 47.7 ± 9%, respectively. The mean ± SEM 2- and 5-year disease-free survival rates were 69.3 ± 6% and 42.6 ± 8%, respectively. Advanced nodal disease (N2, N3 vs. N0, N1: P = 0.031), more advanced tumor stage (T4 vs. T3: P = 0.025), and younger ages (≤ 35 vs. > 35: P = 0.0001) had significant adverse effects on survival rates. There was not a significant difference in survival rates between the chemotherapy regimens of CMF and CAF (P = 0.9). Conclusion: A high recurrence rate in our patients underlines the need for general public education and the design of a program for the early diagnosis of breast cancer in Iran. We should also seek more effective systemic regimens for LABC.