Purpose: Breast - Conserving sur­gery (BCS) has generally been limited to T1 and T2 lesions because it has been thought impossible to achieve good local control with satisfactory cosmesis in patients with more ad­vanced disease . However, many pa­tients with 13 and 14 lesions will ex­hibit dramatic tumor downstaging with neoadjuvant Chemotherapy. It is our hypothesis that for these patients BCS can be performed with good lo­cal control and cosmesis.
Material and Methods : Between February 1999 and Jan 2003, 34 patients with 13/14, NO-N2 . M₀ brea­st cancer completed treatment con­sisting of 4 Courses of (FAC) 500 mg Cyclophosphamid / m2, 50 mg/ m2 of doxorubicin, 500 mg fluoroura-cil every 3 weeks, Surgery (a local
excision if sufficiently downstaged, or mastectomy if not) Followed by another 3 courses of FAC and post radiation therapy. Patients were evaluated for toxicity, local control, cosmesis, disease - free and overall survival.
Results : Median follow-up is 30 months. 15/34 (44%) patients under­went BCS with only one local - region­al failure and actuarial 3- years dis­ease - free and overall survival of 77% and 88%. Cosmetic results were good to excellent in 80% of the pa­tients.
Conclusion : These results suggest that with this regimen a subset of patients with locally ad­vanced breast cancer can preserve their breast with acceptable cosmesis without compromising local control or survival.