These cancers vary widely in biological char- acteristics and clinical behavior, ranging from lo- cally aggressive, but systemically “indolent”, to de novo generalized disease. The prognosis depends on tumor size, extent of lymph node involvement, and the presence or absence of an inflammatory component. Accord- ing to the SEER data (1973-1998), the 3- and 5- year relative survival rates for women with stage III breast cancer are 70% and 55%, respectively. Median survival for women with stage III disease is 4.9 years. The clinical management of LABC is complex and should be tailored to the individual patient. A multidisciplinary approach is recommended combining surgery, radiotherapy and systemic therapy (chemotherapy and/or hormone therapy). Clinical Features Locally Advanced Breast Cancer Locally advanced breast cancer is a hetero- geneous disease, including disease which is ei- ther extensive within the breast and/or ipsilater- al nodal areas (Figures 1, 2, 3). Staging is based on the TNM (tumour, nodes, metastasis) system (Table I). The staging system for breast cancer has varied over time, so categorisation of LABC varies subtly between studies. Some studies of LABC include patients with large tu- mours, e.g. > 5 cm in size. However, the size of the primary tumour on its own does not qualify a tumour for LABC status. These differing def- initions may make comparison of results be- tween studies difficult. Inflammatory Breast Cancer Inflammatory breast cancer (Figure 4) is characterised by rapid onset of diffuse erythe- 283 Abstract. – Locally advanced breast cancer represents a wide variety of neoplasms and con- stitutesapproximately10%-20%ofthenewlydiag- nosed breast cancers. These cancers may have widelydifferentclinicalandbiologicalcharacteris- tics. According to the American Joint Committee on Cancer (AJCC) staging system, all of stage III diseaseisconsideredlocallyadvanced. The clinical treatment of locally advanced breastcanceriscomplexandshouldbetailored to the individual patient. In this paper we dis- cuss the options of management of locally ad- vanced breast cancer, focusing on a multidisci- plinary approach through a combined-modality care involving surgery, radiotherapy and sys- temictherapy. Key Words: Breast cancer, Management, Multidisciplinary ap- proach. Introduction The term locally advanced breast cancer (LABC) encompasses a heterogeneous group of breast neoplasms. In the last revision of the American Joint Committee on Cancer (AJCC) staging system, all of stage III disease is consid- ered locally advanced, including cases with in- volvement of supraclavicular lymph nodes and which often are initially inoperable (T4N2-3). The same applies to inflammatory breast cancer (IBC) featuring marked neoangiogenesis, high grade, aneuploid features, hormone-receptor neg- ative status, high S-phase fraction and p53 muta- tions and a severe prognosis 1-3 . LABC constitutes up to 20% of breast cancer in medically underserved populations in the United States and up to 75% of breast cancers in developing countries 4-7 . European Review for Medical and Pharmacological Sciences 2007; 11: 283-289 CorrespondingAuthor:GianlucaFranceschini,MD;e-mail:g.franceschini@rm.unicatt.it Update in the treatment of locally advanced breast cancer: a multidisciplinary approach G.FRANCESCHINI,D.TERRIBILE,S.MAGNO,C.FABBRI,P.F.D’ALBA, F.CHIESA,A.DILEONE,R.MASETTI BreastUnit,CatholicUniversityofSacredHeart–Rome(Italy)