Abstract
Purpose
To compare patterns of local and regional failure between patients with inflammatory
breast cancer (IBC) and non-IBC in patients treated with trimodality therapy.
Materials and Methods
We reviewed records of 463 patients with stage II/III breast cancer, including IBC,
who completed trimodality therapy from January 1999 to December 2009.
Results
The median follow-up was 46.3 months (range, 4-152 months). Clinical stage was 29.4%
(n = 136) II, 56.4% (n = 261) non-IBC III, 14.2% (n = 66) IBC, 30.5% (n = 141) cN0/Nx,
and 69.5% (n = 322) N1-N3c. All the patients received neoadjuvant therapy and mastectomy
(98%, n = 456 with axillary dissection), and all had postmastectomy radiation therapy
to the chest wall with or without supraclavicular nodes (82.5%, n = 382) with or without
axilla (6%, n = 28). The median chest wall dose was 60.4 Gy. Patients with IBC presented
with larger tumors (P < .001) and exhibited a poorer response to neoadjuvant therapy: after surgery, fewer
patients with IBC were ypN0 (P = .003) and more had ≥ 4 positive nodes (P < .001). Four-year cumulative incidence of locoregional recurrence was 5.9%, with
25 locoregional events, 9 of which had a regional component. On multivariate analysis,
triple-negative disease (hazard ratio [HR] 7.75, P < .0001) and residual pathologic nodes (HR 7.10, P < .001) were associated with an increased risk of locoregional recurrence, but IBC
was not. However, on multivariate analysis, the 4-year cumulative incidence of regional
recurrence specifically was significantly higher in IBC (HR 9.87, P = .005).
Conclusion
In this cohort of patients who completed trimodality therapy, the patients with IBC
were more likely to have residual disease in the axilla after neoadjuvant therapy
and were at greater risk of regional recurrence. Future study should focus on optimizing
regional nodal management in IBC.
Keywords
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References
- Inflammatory cancer of the breast: analysis of 114 cases.J Surg Oncol. 1981; 18: 355-361
- Multimodal treatment for inflammatory breast cancer.Int J Radiat Oncol Biol Phys. 1989; 17: 739-745
- Locoregional treatment outcomes after multimodality management of inflammatory breast cancer.Int J Radiat Oncol Biol Phys. 2008; 72: 474-484
- Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials.Lancet. 2005; 366: 2087-2106
- Effectiveness of mastectomy by response to induction chemotherapy for control in inflammatory breast carcinoma.Ann Surg Oncol. 1997; 4: 452-461
- Alternating chemotherapy and hyperfractionated accelerated radiotherapy in non-metastatic inflammatory breast cancer.Cancer Radiother. 2000; 4 ([in French with English abstract]): 265-273
- Pattern of failure in patients with inflammatory breast cancer treated by alternating radiotherapy and chemotherapy.Cancer. 1995; 76: 2286-2290
- Modern outcomes of inflammatory breast cancer.Int J Radiat Oncol Biol Phys. 2012; 84: 619-624
- Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute.J Natl Cancer Inst. 2005; 97: 966-975
- Dermal lymphatic invasion and inflammatory breast cancer are independent predictors of outcome after postmastectomy radiation.Am J Clin Oncol. 2009; 32: 30-33
Breast cancer. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology—v.2.2013. National Comprehensive Cancer Network [Web site]. Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Access: April 12, 2013.
- Predictors of locoregional outcome in patients receiving neoadjuvant therapy and post-mastectomy radiation.Cancer. 2013; 119: 16-25
The R Development Core Team. R: A Language and Environment for Statistical Computing. (http://www.R-project.org/) R Foundation for Statistical Computing. Version 2.8.0 (2008-10-20) ISBN 3-900051-07-0.
- Inflammatory breast cancer (IBC) and patterns of recurrence: understanding the biology of a unique disease.Cancer. 2007; 110: 1436-1444
- Locoregional outcomes of inflammatory breast cancer patients treated with standard fractionation radiation and daily skin bolus in the taxane era.Int J Radiat Oncol Biol Phys. 2010; 77: 1105-1112
- Breast cancer regional radiation fields for supraclavicular and axillary lymph node treatment: is a posterior axillary boost field technique optimal?.Int J Radiat Oncol Biol Phys. 2009; 74: 86-91
- Triple-negative subtype predicts poor overall survival and high locoregional relapse in inflammatory breast cancer.Oncologist. 2011; 16: 1675-1683
- Prognostic impact of human epidermal growth factor-like receptor 2 and hormone receptor status in inflammatory breast cancer (IBC): analysis of 2,014 IBC patient cases from the California Cancer Registry.Breast Cancer Res. 2009; 11: R9
Article info
Publication history
Published online: July 12, 2013
Accepted:
April 16,
2013
Received in revised form:
April 15,
2013
Received:
November 28,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
