The issue of treating LOCALLY ADVANCED BREAST CANCER has been well assessed with randomised trials. They are just old!
Look at a couple of papers which show the pattern well - S+RTh V S+CTh V S+RTh+CTh (Klefstrom), and S+CTh V R+CTh (De Lena). In fact, S+CTh and RTh+CTh give the same outcome, but inferior to all three. There was also a number of reports from Westmead (Boyages) on this issue (which is why it appeared in the exams!). They claimed single institution numbers the equivalent of RTh+CTh (see PMID: 8138439; Ahern, et al).
Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in stage III breast cancer. II. 5‐year results and influence of levamisole
P. Klefström, P. Gröhn, E. Heinonen, L. Holsti, P. Holsti
Multi modal treatment for locally advanced breast cancer: Results of chemotherapy-radiotherapy versus chemotherapy-surgery
M. De Lena, M. Varini, R. Zucali, D. Rovini, G. Viganotti, P. Valagussa, U. Veronesi, G. Bonadonna
American Journal of Clinical Oncology 4(3):229-236,1981
IN A PROSPECTIVE RANDOMIZED STUDY, the efficacy of two combined modality approaches (chemotherapy plus radiotherapy or chemotherapy plus mastectomy) was tested in a total of 132 women with locally advanced breast cancer. Chemotherapy consisted of Adriamycin plus vincristine (AV) administered for three cycles before either local-regional modality and subsequently for seven additional cycles. Although a higher proportion of women achieved complete remission after mastectomy (100%) compared to women given radiotherapy (60%), the total response rate at the end of combined modality was identical (75%). There was no significant difference between the two treatment groups in terms of patterns of treatment failure, median duration of response, and total survival. Treatment was not influenced by menopausal or estrogen receptor status. Two patients of the surgical group showed Adriamyein-induced cardiomyopathy after cumulative doses less than 500 mg/m2. The results of present study failed to indicate that surgery perse improved the overall results, including local control, over radiotherapy in a combined modality setting. (no PDF available)
Locally advanced breast cancer: defining an optimum treatment regimen.
Ahern V, Barraclough B, Bosch C, Langlands A, Boyages J.
Int J Radiat Oncol Biol Phys. 1994 Mar 1;28(4):867-75.