Mastectomy was ineffective for patients with a locally common tumor (T3, T4, and for most in the N1B or N2 stage). In these cases, radical surgery is contraindicated, and local tumor removal (“cosmetic mastectomy”) is often effective in combination with radiation, chemo- or hormonal therapy, in which the maximum possible degree of control over local tumor growth is achieved. Such a surgical procedure is especially effective in cases of large exophytic cancers.
Usually prefer to carry out radiation therapy. When irradiation is often possible to achieve a fairly high dose, and in 90% of cases over a 5-year period it is possible to control local tumor growth.
However, the survival rate among such patients is only 20-25%. The effectiveness of controlling local tumor growth decreases as the size of the primary tumor increases. The factors determining inoperability and high likelihood of local recurrence include the fixation of the mammary gland to the chest wall and the defeat of the axillary or supraclavicular lymph nodes. The most effective is local irradiation at a high dose.
According to one of the last retrospective observations, after irradiation at a dose of 60 Gy (or more), it was possible to control local tumor growth in 78% of cases, and after irradiation at lower doses – in less than 40% of cases. The purpose of chemotherapy was to reduce the incidence of localized tumor recurrences.
In some cases, especially for elderly patients, tamoxifen is prescribed instead of radiation therapy. This drug works even in cases of a common fast-growing local tumor, and usually six weeks are enough to determine its effectiveness or inefficiency.
Tumors that develop in young women respond more quickly to chemotherapeutic drugs, and therefore, in this case, chemotherapy is the preferred method of treatment. The possibility of prescribing chemotherapy courses should be envisaged even for the elderly, as patients in these age groups can tolerate chemotherapy well in combination with antiemetics and other supportive measures.