Abstract

When seen initially, 10% to 29% of patients with breast cancer have locally advanced, nonresectable lesions without evidence of distant metastases. Radiotherapy offers significant palliation for these patients but has little influence on survival. Preoperative chemotherapy can be used to shrink many of these lesions and make them resectable. Adjuvant chemotherapy for patients with histologically positive nodes is now reasonably well established and allows the treatment of the micrometastases that most of these patients have. Removal of the breast can prevent the development of bleeding, ulcerating masses on the chest wall in the later stages of the disease. The removal of the primary tumor may favorably influence the interdependence of primary and metastatic foci.