[The role of radiotherapy in the multimodal treatment of locally advanced breast carcinoma].

From September 1983 to March 1988, 57 patients with locally-advanced breast cancer were treated at the Istituto Nazionale per la Ricerca sul Cancro in Genoa, Italy. All patients received 3 cycles of induction chemotherapy with estrogenic recruitment before surgery (diethylstilbesterol-DES-FAC) and 6 additional cycles of chemotherapy (3 DES FAC alternating with 3 DES CMF) after surgery. Stage III A (15) patients reached 86% local relapse-free survival (LRFS), 68% disease-free survival (DFS), and 85% overall survival (OS). Stage III B (42) patients had 82% LRFS, 59% DFS, and 33% OS at 5 years. The first site of relapse was locoregional in 35% of the patients: 19% chest wall recurrence, 3.5% chest wall and lymph nodes, and 7% regional nodes; 5% of the cases presented synchronous local and systemic recurrence; distant metastases represented 21% of the initial relapse rate. This therapy appears to improve the prognosis of III A patients more than that of III B patients. Unsatisfactory results were obtained in inflammatory cancer, with 54% of local recurrences. The present study indicates that radiotherapy is necessary to improve local control and to increase DFS in inflammatory breast cancer. Moreover, the use of radiation therapy also improves the results in III A and III B patients.