Locally advanced disease is defined by the presence of infiltration of the skin or the chest wall or fixed axillary nodes. The probability of metastatic disease is high (>70%) but long-term survival is possible and the median survival of these patients exceeds two years.
Local control of the tumour and the prevention of fungation are of major importance to the quality of life of these women. A combination of primary systemic treatment and radiotherapy is commonly used. Many of these patients are elderly and have indolent ER-positive disease that responds to endocrine therapy with tamoxifen, aromatase inhibitors, or progestins. In younger women, particularly with aggressive 'inflammatory' breast cancer, primary chemotherapy is preferred. In patients with a good response to systemic treatment surgery may be feasible.
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