A new approach to the management of primary unresectable carcinoma of the breast: is radiation therapy necessary?

Nearly all patients with locally advanced, inoperable breast cancer have occult metastases. Although radiation therapy may in some cases control local disease, it has no effect on the metastases and thus does not improve survival. Twenty-five patients with locally advanced inoperable breast cancer have been treated at Kaiser Permanente Medical Center during the last 10 years. Review of these patients confirms the limited local control and poor survival of these patients when treated with radiation therapy. A therapeutic plan which both achieves local control and treats distant micrometastases by the combined use of chemotherapy (with or without hormonal manipulation) and surgery is presented. Preoperative response of the primary lesion to therapy has also allowed selection of the proper postoperative adjuvant therapy. An example of this type of therapy with its results is presented in detail. Although preliminary tests are hopeful, obviously a large, controlled clinical trial will be needed to test their validity.