Management of inflammatory breast cancer after neoadjuvant chemotherapy

Int J Radiat Oncol Biol Phys. 2011 Mar 15;79(4):1055-63. doi: 10.1016/j.ijrobp.2009.12.009. Epub 2010 May 17.

Abstract

Purpose: To assess the benefit of breast surgery for inflammatory breast cancer (IBC).

Methods and materials: This retrospective series was based on 232 patients treated for IBC. All patients received primary chemotherapy followed by either exclusive radiotherapy (118 patients; 51%) or surgery with or without radiotherapy (114 patients; 49%). The median follow-up was 11 years.

Results: The two groups were comparable apart from fewer tumors <70 mm (43% vs. 33%, p = 0.003), a higher rate of clinical stage N2 (15% vs. 5%, p = 0.04), and fewer histopathologic Grade 3 tumors (46% vs. 61%, p <0.05) in the no-surgery group. The addition of surgery was associated with a significant improvement in locoregional disease control (p = 0.04) at 10 years locoregional free interval 78% vs. 59% but with no significant difference in overall survival rates or disease-free intervals. Late toxicities were not significantly different between the two treatment groups except for a higher rate of fibrosis in the no-surgery group (p <0.0001) and more lymphedema in the surgery group (p = 0.002).

Conclusion: Our data suggest an improvement in locoregional control in patients treated by surgery, in conjunction with chemotherapy and radiotherapy, for IBC. Efforts must be made to improve overall survival.

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery
  • Cyclophosphamide / administration & dosage
  • Disease-Free Survival
  • Drug Administration Schedule
  • Female
  • Fluorouracil / administration & dosage
  • Follow-Up Studies
  • Humans
  • Inflammatory Breast Neoplasms / drug therapy*
  • Inflammatory Breast Neoplasms / pathology
  • Inflammatory Breast Neoplasms / radiotherapy*
  • Inflammatory Breast Neoplasms / surgery
  • Middle Aged
  • Neoadjuvant Therapy / methods
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Retrospective Studies
  • Survival Rate
  • Vinblastine / administration & dosage
  • Vinblastine / analogs & derivatives
  • Vindesine / administration & dosage
  • Vinorelbine

Substances

  • Vinblastine
  • Cyclophosphamide
  • Vinorelbine
  • Vindesine
  • Fluorouracil