Figure 26.27. These are a very heterogeneous group of tumours with widely differing natural histories. Results with surgery and radiotherapy were disappointing with high levels of locoregional and systemic failure. Substantial improvements have been achieved with the addition of systemic therapy. Nonetheless, long-term survival is only about 50%. The evidence base is much weaker than for early breast cancer. Much of the published literature is based on case series, with mixed populations of patients some including patients with inflammatory breast cancer and others not. Often, in studies of systemic therapy, locoregional therapy is not well defined. However, long-term survival remains poor at about 50% and systemic failure remains a major problem.

Figure 26.27 Locally advanced and inoperable carcinoma of the right breast (T4).

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