Once Daily Radiation Therapy for Inflammatory Breast Cancer

Abstract

Purpose/Objective(s)Inflammatory breast cancer (IBC) is an aggressive breast cancer variant that portends a poor prognosis, with 5-year overall survival (OS) typically reported at 40-45%. Many published series employ twice-daily radiation therapy (RT) to compensate for the rapid proliferation that has been demonstrated in IBC. Once daily radiation with daily bolus through treatment has been the standard RT technique used in trimodality therapy. Herein, we report our outcomes with this approach.Materials/MethodsReview of medical records was performed to identify patients treated with RT for IBC from 2000 through 2010. Patients with non-metastatic, clinically diagnosed IBC were included. OS and disease-free survival (DFS) were assessed using the Kaplan Meier method. Recurrence in the chest wall or regional lymph nodes was defined as locoregional recurrence (LRR). IRB approved this protocol.ResultsFifty-two women were included in the analysis. Median age at diagnosis was 54 years (range, 23-83 years). The majority of patients had clinically involved nodes (81%) and tumors that were of ductal histology (90%), Nottingham grade III (65%) and estrogen receptor (ER) positive (56%). Ninety-four percent received neoadjuvant chemotherapy and 46% received adjuvant chemotherapy. All but 1 patient (98%) received chemotherapy at some point in their treatment. All patients underwent mastectomy and 98% had axillary dissection; one patient has sentinel lymph node biopsy. Ten patients had pathologic complete response to neoadjuvant chemotherapy. All patients were treated with adjuvant RT. Radiation was delivered in once daily fractions of 1.8-2.25 Gy (median 2 Gy). The chest wall and draining nodal volumes were treated to a median of 50 Gy (range, 46-60 Gy). Sixty-two percent of patients received a boost to the mastectomy scar with a median dose of 10 Gy (range, 10-16 Gy). Daily bolus was employed in 90% of patients. This was, most commonly (68%), 1 cm in thickness. Median follow-up for the population was 3.6 years (range, 0.7-11.9 years). Five-year OS was 64%. Five-year DFS was 54%. Six women experienced LRR, for a crude local control rate of 88%. LRR was associated with poorer DFS and OS (p < 0.01 and p = 0.02, respectively). On univariate analysis, age greater than 50 years correlated with better 5-year DFS (65% versus 40%, p = 0.037) but had no effect on OS. ER status and response to chemotherapy were not associated with OS or DFS.ConclusionsOur outcomes with once daily RT for IBC compare favorably to other reports in the literature. This supports the efficacy of once daily treatments, which are more convenient for patients and less resource intensive. Women younger than 50 years of age had poorer DFS than their older counterparts, in keeping with previously reported data. Purpose/Objective(s)Inflammatory breast cancer (IBC) is an aggressive breast cancer variant that portends a poor prognosis, with 5-year overall survival (OS) typically reported at 40-45%. Many published series employ twice-daily radiation therapy (RT) to compensate for the rapid proliferation that has been demonstrated in IBC. Once daily radiation with daily bolus through treatment has been the standard RT technique used in trimodality therapy. Herein, we report our outcomes with this approach. Inflammatory breast cancer (IBC) is an aggressive breast cancer variant that portends a poor prognosis, with 5-year overall survival (OS) typically reported at 40-45%. Many published series employ twice-daily radiation therapy (RT) to compensate for the rapid proliferation that has been demonstrated in IBC. Once daily radiation with daily bolus through treatment has been the standard RT technique used in trimodality therapy. Herein, we report our outcomes with this approach. Materials/MethodsReview of medical records was performed to identify patients treated with RT for IBC from 2000 through 2010. Patients with non-metastatic, clinically diagnosed IBC were included. OS and disease-free survival (DFS) were assessed using the Kaplan Meier method. Recurrence in the chest wall or regional lymph nodes was defined as locoregional recurrence (LRR). IRB approved this protocol. Review of medical records was performed to identify patients treated with RT for IBC from 2000 through 2010. Patients with non-metastatic, clinically diagnosed IBC were included. OS and disease-free survival (DFS) were assessed using the Kaplan Meier method. Recurrence in the chest wall or regional lymph nodes was defined as locoregional recurrence (LRR). IRB approved this protocol. ResultsFifty-two women were included in the analysis. Median age at diagnosis was 54 years (range, 23-83 years). The majority of patients had clinically involved nodes (81%) and tumors that were of ductal histology (90%), Nottingham grade III (65%) and estrogen receptor (ER) positive (56%). Ninety-four percent received neoadjuvant chemotherapy and 46% received adjuvant chemotherapy. All but 1 patient (98%) received chemotherapy at some point in their treatment. All patients underwent mastectomy and 98% had axillary dissection; one patient has sentinel lymph node biopsy. Ten patients had pathologic complete response to neoadjuvant chemotherapy. All patients were treated with adjuvant RT. Radiation was delivered in once daily fractions of 1.8-2.25 Gy (median 2 Gy). The chest wall and draining nodal volumes were treated to a median of 50 Gy (range, 46-60 Gy). Sixty-two percent of patients received a boost to the mastectomy scar with a median dose of 10 Gy (range, 10-16 Gy). Daily bolus was employed in 90% of patients. This was, most commonly (68%), 1 cm in thickness. Median follow-up for the population was 3.6 years (range, 0.7-11.9 years). Five-year OS was 64%. Five-year DFS was 54%. Six women experienced LRR, for a crude local control rate of 88%. LRR was associated with poorer DFS and OS (p < 0.01 and p = 0.02, respectively). On univariate analysis, age greater than 50 years correlated with better 5-year DFS (65% versus 40%, p = 0.037) but had no effect on OS. ER status and response to chemotherapy were not associated with OS or DFS. Fifty-two women were included in the analysis. Median age at diagnosis was 54 years (range, 23-83 years). The majority of patients had clinically involved nodes (81%) and tumors that were of ductal histology (90%), Nottingham grade III (65%) and estrogen receptor (ER) positive (56%). Ninety-four percent received neoadjuvant chemotherapy and 46% received adjuvant chemotherapy. All but 1 patient (98%) received chemotherapy at some point in their treatment. All patients underwent mastectomy and 98% had axillary dissection; one patient has sentinel lymph node biopsy. Ten patients had pathologic complete response to neoadjuvant chemotherapy. All patients were treated with adjuvant RT. Radiation was delivered in once daily fractions of 1.8-2.25 Gy (median 2 Gy). The chest wall and draining nodal volumes were treated to a median of 50 Gy (range, 46-60 Gy). Sixty-two percent of patients received a boost to the mastectomy scar with a median dose of 10 Gy (range, 10-16 Gy). Daily bolus was employed in 90% of patients. This was, most commonly (68%), 1 cm in thickness. Median follow-up for the population was 3.6 years (range, 0.7-11.9 years). Five-year OS was 64%. Five-year DFS was 54%. Six women experienced LRR, for a crude local control rate of 88%. LRR was associated with poorer DFS and OS (p < 0.01 and p = 0.02, respectively). On univariate analysis, age greater than 50 years correlated with better 5-year DFS (65% versus 40%, p = 0.037) but had no effect on OS. ER status and response to chemotherapy were not associated with OS or DFS. ConclusionsOur outcomes with once daily RT for IBC compare favorably to other reports in the literature. This supports the efficacy of once daily treatments, which are more convenient for patients and less resource intensive. Women younger than 50 years of age had poorer DFS than their older counterparts, in keeping with previously reported data. Our outcomes with once daily RT for IBC compare favorably to other reports in the literature. This supports the efficacy of once daily treatments, which are more convenient for patients and less resource intensive. Women younger than 50 years of age had poorer DFS than their older counterparts, in keeping with previously reported data.