Abstract
One hundred and seventy-eight patients with non metastatic inflammatory breast cancer (IBC) have been treated at the Centre H. Becquerel. Median follow up is 67 months (6-178). Every patient received neoadjuvant chemotherapy (mean number of cycles = 4; range: 2-8), followed by a loco regional treatment (radiotherapy = XRT or modified radical mastectomy = S), followed by adjuvant chemotherapy. During this period, the types of chemotherapy and locoregional treatment have been the following: Study I: 64 patients treated with CMF or AVCF and XRT; Study II: 83 patients, treated with either AVCF, FAC or VAC followed by S (n = 38) or XRT (n = 22) in case of complete or partial response, or followed by XRT (23) in case of initial supraclavicular lymph node involvement or lack of response after chemotherapy; Study III: 31 patients treated with FEC-HD + Estrogenic recruitment followed by S and XRT after adjuvant chemotherapy, except seven patients who received XRT (refusal of surgery). Although objective response rates (= 56.2, 73.5 and 93.5% for study I, II and III respectively) are statistically better in the 3rd study, this does not translate in dramatically different disease free survival (median = 16.7, 19 and 22.2 months respectively for study I, II and III) or overall survival (median = 25, 45.7 and 32.6 months respectively for study I, II and III). Analysis of subset of patients without supra clavicular lymph node involvement where neoadjuvant chemotherapy obtained at least a 50% response reveals a median disease free survival and median overall survival of respectively 38.3 and 60.1 months for patients who underwent S vs 19 and 38.3 months for those who received XRT (P = 0.15). These studies suggest that surgery has no deleterious effect on outcome of IBC. Advantage on disease free survival or overall survival from intensive chemotherapy in IBC remains to be proven with appropriate randomised trials.
Highlights
Because of the poor results in loco regional control with high incidence of intramammary remainders and loco regional relapses observed in the first study (Chevallier et al, 1987), we decided to test the value of surgery as loco regional treatment. This was done for the patients with no supra clavicular lymph node involvement achieving at least a good partial response with disappearance of erythema after induction chemotherapy
Response rates were estimated at the end of induction chemotherapy
Overall response rates were determined taking into account both the breast tumour, the lymph nodes and the inflammatory signs
Summary
Because of the poor results in loco regional control with high incidence of intramammary remainders and loco regional relapses observed in the first study (Chevallier et al, 1987), we decided to test the value of surgery as loco regional treatment This was done for the patients with no supra clavicular lymph node involvement achieving at least a good partial response with disappearance of erythema after induction chemotherapy. Twenty-three patients had either supra clavicular lymph node involvement or achieved stabilisation or progressive disease after induction therapy These 23 patients received exclusive radiotherapy for loco regional treatment. When we consider the main prognostic factors, no statistical difference was observed between the patients of the second study who received surgery or radiotherapy after efficient induction chemotherapy. The objective response rate (CR + PR) was 53.1% in the first study, 73.5% in the second one and 93.5% in the third study
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