Current data suggest that patients with advanced stage III disease who are at least T3 (>5 cm in maximal diameter), T4 (extension to chest wall or skin), or N2 (fixed or matted axillary lymphadenopathy) are best treated with preoperative chemotherapy or hormonal therapy, followed by surgery and then local-regional fractionated radiation therapy. Limited data support the addition of adjuvant chemotherapy or hormonal therapy postoperatively and after radiation therapy. Excellent local control can be achieved in 80% to 90% of women, and approximately 30% of women with stage IIIb disease (direct invasion of skin or chest wall) or inflammatory breast cancer remain free of cancer after 1 year.24,68
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