Prognosis in inoperable Stage III carcinoma of the breast

Abstract One hundred and eighty-four patients with inoperable Stage III breast cancer presenting to the Guy's Hospital Breast Unit between 1961–1973 were treated initially by radiotherapy alone. The response rate was 60% but duration of response and survival were short. Seventy-two per cent of patients did not have prolonged control of local disease and 63% developed distant metastases. The association between certain prognostic variables and response to radiotherapy, subsequent development of metastases and survival was analysed statistically. The duration of response to radiotherapy showed no significant associations with any prognostic variable. Subsequent distant metastases occurred less often in patients responding to radiotherapy, having a subsequent mastectomy or if the duration of symptoms before presentation was long, but more frequently if the primary tumours were diffuse. Survival was shorter in patients who were early postmenopausal, had a short duration of symptoms or had diffusc primary tumours. Improved survival was associated with a good response to radiotherapy and, unexpectedly, with deep fixation of the primary tumour. Prognosis was not significantly associated with size of primary tumour or involvement of skin or lymph nodes. The effectiveness of combining variables in predicting prognosis is described. A further group of 30 patients, unsuitable for radiotherapy were treated primarily by additive endocrine therapy and had a median survival of 14 months. The clinical course of Stage III breast cancer is variable, there being two extremes: a slowly-growing, non-metastasising form and a more common, rapidly-growing, metastasising form. For prognosis to be improved, systemic therapy as part of the primary management of this disease may be necessary. Prognostic variables should be considered in the design and assessment of future clinical trials.