Clinical investigation: breast
Ten-year outcome after combined modality therapy for inflammatory breast cancer

Presented in part at the 42nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology, San Francisco, CA, 2001.
https://doi.org/10.1016/S0360-3016(02)04201-3Get rights and content

Abstract

Purpose

To evaluate the long-term outcome of combined modality therapy for inflammatory breast cancer.

Methods and materials

The data from 54 women treated between 1983 and 1996 for inflammatory breast cancer were analyzed. Patients with metastatic disease or disease progression on induction chemotherapy were excluded. Induction chemotherapy was given to 52 patients. Mastectomy was performed in 52 patients. Radiotherapy was delivered to the breast or chest wall and regional lymph nodes in all patients. The median follow-up for all patients was 5.1 years.

Results

The 5- and 10-year overall survival rate was 56% and 35%, respectively; the corresponding relapse-free survival rates were 49% and 34%. Patients with a pathologic complete response after chemotherapy with or without preoperative radiotherapy had better 5- and 10-year overall survival rates (65% and 46%, respectively) and 5- and 10-year relapse-free survival rates (59% and 50%, respectively) compared with patients without a pathologic complete response. Those patients had a 5- and 10-year relapse-free survival rate of 45% and 27%, respectively. Locoregional failure at 5 and 10 years was 8% and 19%, respectively.

Conclusion

The outcomes for patients completing multimodality therapy compare favorably with published data; however, the exclusion of patients with progression during induction chemotherapy may account in part for these results. The pathologic complete response rate was found to be an important prognostic factor. Selected patients with inflammatory breast cancer have the potential for long-term survival.

Introduction

Inflammatory breast cancer is an uncommon disease presentation with a poor prognosis reported historically. Lee and Tannenbaum (1) used the term “inflammatory breast cancer” in a 1924 paper describing the clinical entity. Clinically, inflammatory breast cancer is characterized by erythema and edema of the skin of the breast, called peau d’orange, with or without an associated palpable mass (2). Infiltration of the dermal lymphatics is often seen, but its documentation is not necessary for a diagnosis of inflammatory carcinoma (3). Inflammatory breast cancer is characterized by a rapid onset often associated with palpable axillary adenopathy and distant metastases (4).

Inflammatory breast cancer represents approximately 1–6% of all breast cancers 5, 6. The Surveillance, Epidemiology, and End Results program recently reported data estimates that the incidence of inflammatory breast cancer has approximately doubled during the past two decades (7). The reported 5-year overall survival rates range from 10% (8) to 75% (9).

The treatment of this disease has evolved significantly during the past three decades, incorporating surgery, radiotherapy (RT), and chemotherapy for local and distant disease control. Although no standard management has been defined for this disease, neoadjuvant chemotherapy with surgery and RT for locoregional disease has become accepted practice, with or without additional systemic treatment after completion of local therapy. The diversity of treatment sequencing, chemotherapeutic agents used, and total duration of systemic treatment makes the comparison of clinical trials difficult. More recently, high-dose chemotherapy with bone marrow or peripheral stem cell transplantation has been used in an attempt to improve the outcome in this disease, although only short-term results are available 10, 11.

The present study was undertaken to evaluate the long-term outcomes of multimodality treatment, including neoadjuvant chemotherapy, surgery, and RT, in patients with inflammatory breast cancer.

Section snippets

Methods and materials

The medical records of 54 patients presenting with inflammatory breast cancer treated in the Department of Radiation Oncology of the Hospital of the University of Pennsylvania between 1983 and 1996 were reviewed. Patients were not included if they lacked clinical findings of inflammatory cancer or if they had a synchronous contralateral breast cancer or metastatic disease at presentation. Patients with inflammatory breast cancer who experienced disease progression during neoadjuvant

Results

The 5- and 10-year overall survival rate was 56% and 35%, respectively (Fig. 1). Table 3 summarizes the actuarial results for the entire group. No patient died of intercurrent disease; all deaths were due to breast cancer. The 5- and 10-year relapse-free survival rate was 49% and 34%, respectively. Thirty-four patients developed metastatic disease, and all died of disease. The remaining 20 patients were all alive and free of disease at their last follow-up.

Potential prognostic factors were

Discussion

Inflammatory breast cancer is characterized by a high rate of locoregional recurrence after surgery alone and the rapid appearance of distant metastases. However, long-term survival is possible for patients presenting with this diagnosis and treated with multimodality therapy. As used in the present series, the combination of neoadjuvant chemotherapy, mastectomy, and pre- or postoperative RT to the chest wall and regional lymph nodes achieves the best outcomes for patients with this aggressive

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