Diagnosis and management of inflammatory breast cancer

Abstract

Inflammatory breast carcinoma (IBC) is the most lethal and fulminant of all breast cancers. IBC can be either clinically or pathologically defined, but the prognosis is equally poor, whether it is diagnosed using clinical or pathological criteria or a combination of both. Rapid growth and short doubling times are characteristic of IBC, resulting in local growth analogous to a "brush fire," extending rapidly in all directions across all surfaces and tissue planes. In addition, rapid systemic dissemination results in the death of the majority of these patients. Traditional treatment of IBC consisted of surgery or radiation therapy alone, with cure rates rarely achieving 15%. The advent of successful combination chemotherapy regimens, along with local irradiation of the breast and regional lymphatics, has increased the 5-year disease-free survival rate to 35% to 50%. In spite of recent innovative European programs combining radiation therapy and chemotherapy without mastectomy, optimal treatment is still considered to be induction chemotherapy, mastectomy, and comprehensive chest wall/nodal irradiation following by maintenance chemotherapy. Some centers are also investigating accelerated radiation therapy fractionation schemes that may further improve local control through maximizing the radiobiological response of tumor cells. Attention to radiotherapy technique can minimize local-regional tumor control and minimize long-term complications. There is considerable room for improvement. Numerous studies are in progress attemping to improve survival rates, including use of autologous bone marrow transplantation. Better systemic agents and more effective drug combinations are needed. Once systemic micrometastases are reliably eradicated, improvement in local-regional control will become even more important for IBC patients.