Inflammatory Breast Cancer: What Should Be the Locoregional Treatment after Primary Chemotherapy?

Abstract

Abstract Purpose: The aim of this retrospective, mono-centric, study was to assess the benefit of breast surgery for inflammatory breast cancer (IBC).Patients and methods:From January 1st 1985 and December 31st 1999; out of 13180 patients diagnosed at the Institut Curie with non metastatic breast cancer, 280 (2%) were treated with curative intent for IBC with primary chemotherapy followed by either exclusive radiotherapy (118 patients, 51%) or surgery with or without radiotherapy (114 patients, 49%). Median follow-up of 11 years.Results:The two groups were comparable apart from a higher rate of tumors smaller than 70mm (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 5 years locoregional free interval was 79% in the surgery group vs 66 % in the exclusive radiotherapy group and at 10 years: 78 % vs 59 % respectively.In the univariate analysis, in addition to the absence of surgery (p=0.04), other prognostic factors associated with higher locoregional recurrence rates were: high clinical nodal stage (p=0.009), high histological nodal status (p=0.02) and the absence of taxanes in the neoadjuvant chemotherapy regimen (p=0.02). In the multivariate analysis, only the clinical N2 stage was associated with a higher rate of locoregional recurrences. There were no significant difference in overall survival (52% at 5 years, 38% at 10 years, p=0.32) or disease-free interval (at 5 years 32%, at 10 years 6%,p=0.35).Factors associated in univariate analyses with a decreased overall survival were age over 50 years, the absence of achievement of a clinical response ≥ 50%, absence of hormone receptors and the absence of taxanes in the neoadjuvant chemotherapy regimen.In multivariate analysis, only the absence of hormone receptors and either complete or partial clinical tumor response remained significant.Factors associated in univariate analyses with a higher rate of disease recurrences were the absence of achievement of a clinical response ≥ 50%, absence of hormone receptors and the absence of taxanes in the neoadjuvant chemotherapy regimen.In multivariate analysis, only the absence of hormone receptors and of clinical tumor response remained significant. 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:This study seems to confirm that the addition of breast surgery to radiotherapy should contribute to increase local control after induction chemotherapy. IBC, despite combined modality treatment, continues to suffer from dismal prognosis and efforts must be made to improve overall survival. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5120.