International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: breastTen-year outcome after combined modality therapy for inflammatory breast cancer
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.
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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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