New Strategies for Locally Advanced Breast Cancer: A Review of Inflammatory Breast Cancer and Nonresponders

Abstract

This review explores the new strategies around the management of locally advanced breast cancer (LABC), particularly for nonresponsive tumors and/or initially unresectable tumors at diagnosis, inclusive of inflammatory breast cancer. Nonresponders to neoadjuvant systemic therapy present a unique clinical challenge. Emerging medical therapeutics as well as considerations for use of radiotherapy and/or surgery in this setting are discussed. Specifically, the use of neoadjuvant radiotherapy for LABC and lymphedema prevention with lymphatic reconstruction following axillary lymph node dissection are reviewed.

Keywords: Breast cancer-related lymphedema; Breast surgery; Lymphatic reconstruction; Neoadjuvant systemic therapy; Radiotherapy.

Figure 1.

(A) Lymphovenous bypass under white light: pictured are 2 lymphatic structures anastomosed to a top vein and lower vein branch, respectively. (B) The same lymphovenous bypass under a fluorescein filter: the dye flows through the anastomosis into the vein; the valve of vein is present, which prevents the backflow of blood. (Images courtesy of Dr. Michelle Coriddi of Memorial Sloan Kettering Cancer Center, New York, NY, USA)