Management Of Inflammatory Breast Cancer Research Articles

Local-Regional Treatment of the Patient With Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a diagnosis based on a constellation of clinical features including a rapid onset of breast erythema and edema (peau d’orange) of a third or more of the skin of the breast and with a palpable border to the edema. Incidence has increased although it makes up only 1–4 % of all breast cancer diagnoses. In spite of some encouraging recent clinical outcome data, published local-regional control rates are consistently lower than expected in non-IBC and are of particular concern in this disease that readily progresses locally to carcinoma en cuirasse. With a focus on radiotherapy, this review provides a critical evaluation of the recent literature evaluating local-regional treatment of IBC, highlights new findings in the local-regional management of IBC, and offers an introduction to future directions regarding the optimal treatment and management of IBC.

Management of Inflammatory breast cancer: current concepts

Abstract is not required for Editorialis not required for Editorial (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 6 No. 7, July 2015. ISSN – [0976-3198] Int J Case Rep Images 2015;6(7):460–461. www.ijcasereportsandimages.com Alawad 460 CASE REPORT OPEN ACCESS Management of Inflammatory breast cancer: current concepts

Inflammatory Breast Cancer Management in the National Comprehensive Cancer Network: The Disease, Recurrence Pattern, and Outcome

BackgroundInflammatory breast cancer (IBC) is an uncommon clinicopathologic entity characterized by rapid progression and aggressive behavior. We used the National Comprehensive Cancer Network (NCCN) Outcomes Database to characterize recurrence patterns and outcomes. MethodsPatients with newly diagnosed IBC treated between 1999 and 2009 at 12 NCCN institutions were identified, and baseline characteristics were obtained. Patients had multimodality therapy if they received 2 of 3 treatments: surgery, perioperative (neoadjuvant or adjuvant) chemotherapy, or perioperative radiation. The first site of recurrence/metastatic diagnosis was identified. Overall survival was calculated on the basis of stage at diagnosis and receipt of multimodality therapy. ResultsWe identified 673 patients, of whom 195 (29%) had metastatic disease at presentation. Median follow-up was 29 months. Of patients in stage III, 82% received > 1 treatment modality. Among 203 patients in stage III with recurrence, the most frequent sites of first recurrence were bone (28%), central nervous system (CNS), lung, and liver (all 21%). Human epidermal growth factor receptor 2 positive and triple negative subtypes had higher rates of CNS recurrence (P = .001). Median survival was 66 months (95% confidence interval [CI], 54-107) for stage III and 26 months (95% CI, 22-33) for stage IV. Among 82% of patients in stage III receiving multimodality therapy, the median survival was 107 months (95% CI, 71 to not reached). ConclusionsThis large, retrospective, multi-institutional study confirms the aggressive clinical features, unique recurrence patterns, and adverse prognosis of IBC. The high rate of CNS recurrence among high-risk subtypes, despite the inflammatory nature of the breast cancer, suggests that new strategies are needed for earlier detection or prevention of brain metastases to improve long-term prognosis.

Inflammatory Breast Cancer Misdiagnosed as Mastitis

Background: Inflammatory breast cancer (IBC) is a rapidly progressive disease associated with high mortality in developing countries. The patients are managed for mastitis’s first and IBC becomes a diagnosis of exclusion after failed response to appropriate antibiotic therapy. This study was aimed at evaluating the outcome of management of IBC in North central Nigeria. Patients and method: This was a prospective analysis of consecutive patients presenting with breast cancer at the Abubakar Tafawa Balewa University teaching hospital Bauchi (ATBUTH) from January 2011 to December 2012. Results: A total of 52 breast cancers were managed, mean age was 31+/- 2years with an age range of 29 -33 years. There were 51 females and 1male (m: f = 51:1) with IBC accounting for 9(17.3 %) of them. Conclusion: IBC is frequently misdiagnosed as mastitis for various reasons and a high index of suspicion is required to clinch the diagnosis.

Inflammatory Breast Cancer: Still a Diagnostic Dilemma

Background: Inflammatory breast cancer (IBC) is a rapidly progressive disease associated with high mortality in developing countries. The patients are managed for mastitis’s first and IBC becomes a diagnosis of exclusion after failed response to appropriate antibiotic therapy. This study was aimed at evaluating the outcome of management of IBC in North central Nigeria. Patients and method: This was a prospective analysis of consecutive patients presenting with breast cancer at the Abubakar Tafawa Balewa University teaching hospital Bauchi (ATBUTH) from January 2011 to December 2012. Results: A total of 52 breast cancers were managed, mean age was 31+/- 2years with an age range of 29 -33 years. There were 51 females and 1male (f: m = 51:1). IBC accounted for 9(17.3 %) of the breast cancers. Conclusion: IBC is frequently misdiagnosed as mastitis for various reasons and a high index of suspicion is required to clinch the diagnosis.

What Radiologists Need to Know about Diagnosis and Treatment of Inflammatory Breast Cancer: A Multidisciplinary Approach

Inflammatory breast cancer (IBC) is a rare breast cancer with a highly virulent course and low 5-year survival rate. Trimodality treatment that includes preoperative chemotherapy, mastectomy, and radiation therapy is the therapeutic mainstay and has been shown to improve prognosis. Proper diagnosis and staging of IBC is critical to treatment planning and requires a multidisciplinary approach that includes imaging. Patients with IBC typically present with rapid onset of breast erythema, edema, and peau d'orange. Both tissue diagnosis of malignancy and clinical findings of inflammatory disease are required to confirm diagnosis of IBC. Imaging is used to identify a biopsy target; direct biopsy; stage IBC; differentiate curable from incurable (stage IV) disease; and help plan chemotherapy, surgical management, and radiation therapy. Comparison of baseline and posttreatment images helps confirm and quantitate disease response. When imaging is used early in the course of therapy to noninvasively predict treatment response, optimal tailored strategies for management of IBC can be implemented. Imaging is vital to diagnosis and treatment planning for patients with IBC, and radiologists are an integral part of the multidisciplinary patient care team.

Inflammatory Breast Cancer: What We Know and What We Need to Learn

We review the current status of multidisciplinary care for patients with inflammatory breast cancer (IBC) and discuss what further research is needed to advance the care of patients with this disease. We performed a comprehensive review of the English-language literature on IBC through computerized literature searches. Significant advances in imaging, including digital mammography, high-resolution ultrasonography with Doppler capabilities, magnetic resonance imaging, and positron emission tomography-computed tomography, have improved the diagnosis and staging of IBC. There are currently no established molecular criteria for distinguishing IBC from noninflammatory breast cancer. Such criteria would be helpful for the diagnosis and development of novel targeted therapies. Combinations of neoadjuvant systemic chemotherapy, surgery, and radiation therapy have led to an improved prognosis; however, the overall 5-year survival rate for patients with IBC remains very low (∼30%). Sentinel lymph node biopsy and skin-sparing mastectomy are not recommended for patients with IBC. Optimal management of IBC requires close coordination among medical, surgical, and radiation oncologists, as well as radiologists and pathologists. There is a need to identify molecular changes that define the pathogenesis of IBC to enable eradication of IBC with the use of IBC-specific targeted therapies.

Lessons Learned from an Unusual Case of Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare breast malignancy that is associated with poor long-term outcomes despite aggressive surgical and chemotherapeutic interventions. We recently treated a 56-year-old woman with right-sided IBC and biopsy-proven cutaneous metastases to her back and left breast. She underwent chemotherapy, bilateral modified radical mastectomy, and radiation therapy. One year after diagnosis, she is currently disease-free based on positron-emission tomography (PET) imaging and repeat skin biopsies. To provide insight into the management of IBC, we present this interesting case with a reflection on important lessons to be learned.

An update on inflammatory breast cancer

Inflammatory breast cancer is one of the most aggressive forms of breast cancer. Once considered to be a uniformly fatal disease, treatment of this entity has evolved significantly over the last two decades. In this article, we review the epidemiology, pathology, biologic underpinnings, radiologic advances, and treatment modalities for inflammatory breast cancer. Updates in surgical therapy, medical oncologic therapy and radiation therapy are reviewed. Emphasis is on cutting edge information regarding inflammatory breast cancer. The management of inflammatory breast cancer is best served by a multidisciplinary team. Continued research into molecular pathways and potential targets is imperative. Future clinical trials should include evaluation of conventional therapy with targeted therapies.

Overcoming radiation resistance in inflammatory breast cancer.

The clinical-pathological features of inflammatory breast cancer include enrichment of factors that have been previously associated with radioresistant disease, including negative hormone receptor status and a phenotype enriched for relatively radioresistant breast cancer stem/progenitor cells. The risks and benefits of accelerated postmastectomy radiation treatment regimens in the multimodality management of inflammatory breast cancer were reviewed at the first International Inflammatory Breast Cancer Conference at The University of Texas M. D. Anderson Cancer Center. The biological basis for radiation resistance and strategies to radiosensitize these tumors were also presented. The prevalent basal phenotype of inflammatory breast cancer makes it an ideal clinical model to examine stem cell hypotheses, which the authors believe can help guide future trials to continue making incremental progress against this aggressive disease.

Biology and management of inflammatory breast cancer

Inflammatory breast cancer is an aggressive subtype of a locally advanced breast cancer that is thought to account for approximately 1–5% of all newly diagnosed breast cancers diagnosed in the USA. Historically, IBC was considered to be a uniformly fatal disease with less than 5% of patients surviving past 5 years. With the advent of a multidisciplinary approach to management, survival outcomes have improved with 5-year survival rates of over 40% being reported. Research efforts are now focused on trying to better understand the epidemiological and molecular characteristics of this disease to further improve survival. Two genes, Rhoc GTPase and WISP3, have been identified that have been found to be concordantly altered in the majority of inflammatory breast cancer tumors and may serve as potential targets for future therapeutic agents. The purpose of this review is to summarize the latest epidemiological and molecular characteristics of IBC, describe the difficulties encountered in trying to clinically diagnose this entity, highlight the importance of a multidisciplinary approach and present some of the latest data on the management of this disease.

High Proportion of Inflammatory Breast Cancer in the Population-Based Cancer Registry of Gharbiah, Egypt

To the Editor: Inflammatory breast cancer (IBC), the most lethal form of breast cancer, constitutes 1‐2% of all breast cancers in the United States (1). Breast cancer comprises 352% of women’s cancers in the Gharbiah cancer registry (GCR) of Egypt (2). Hospital-based studies from the National Cancer Institute of Cairo University (NCI-Cairo) in Egypt suggested that IBC accounts for 10% of breast cancers (3). However, these estimates lacked confirmation from populationbased studies. To remedy this deficit, we performed this study to evaluate the frequency and features of IBC in GCR. Our initial review of GCR data between 1999 and 2003 showed that IBC did not exist despite the clinical experience with frequent cases of IBC at the GCR and the 10% relative frequency of the disease at NCICairo. A multi-disciplinary group of physicians in Egypt and the United States, who were experienced in the diagnosis and management of IBC, collaboratively developed an 84-item checklist of symptoms, signs, and clinical characteristic suggestive of IBC to facilitate and standardize abstraction of information from medical records. IBC cases were identified using the simplified clinical definition of Merajver and Sabel (4) that used erythema, edema, and peau d’orange as the three main clinical features of IBC. Subsequently, cases were grouped as follows: most-likely IBC exhibited all three features, possible IBC cases had any two of the three symptoms or had peau d’orange only, and non-IBC cases had edema only, erythema only, or had none of these three clinical features. IBC status was based on clinical criteria for IBC diagnosis (erythema, edema, and peau d’orange). The checklist was applied to all cases that had at least one of the three defining features of IBC and missing data was denoted. The study population had 659 cases, comprising four with most-likely IBC, 69 with possible IBC, and 586 who were non-IBC. IBC proportion was calculated according to two different definitions. Under the most stringent definition, most-likely IBC cases were considered as IBC, the proportion of IBC was 0.6%. Under a definition that both most-likely IBC cases and possible IBC cases were considered as IBC, the IBC proportion was 11.1%. There was no difference in age, parity, menopausal status, concurrent lactation, or family history between the IBC versus non-IBC groups. Warmth, diffuse enlargement, and nipple retraction were significantly higher among the IBC group compared with the non-IBC group (5.5% versus 0.2% with warmth, p < 0.01; 8.2% versus 0.7% with diffuse enlargement, p < 0.01; and 60.9% versus 8.2% with nipple retraction, p < 0.01, among IBC versus non-IBC groups, respectively). There were no significant differences between the two groups in bruising, palpable mass, or ulceration. The IBC group had 12.5% tumor emboli compared with 3.6% among the non-IBC group (p = 0.02). More patients (42.5%) in the IBC group received neo-adjuvant chemotherapy compared with 15.4% in the non-IBC group (p < 0.01). While 81.9% of the non-IBC group received surgical resection or radiotherapy (73.4%), this proportion was significantly higher than patients receiving resection or radiotherapy among the IBC group (53.5% and 51.9%, both p < 0.01). There was no significant difference between the IBC versus non-IBC groups in tumor grade, angiolymphatic invasion, or adjuvant chemotherapy. IBC cases had higher rate of metastasis (41.7%) compared with 27.8% for the non-IBC group (p = 0.10). Hormone receptors were higher in the IBC group than the non-IBC group (36.4% versus 16.7%, p < 0.01 for ER; 58.3% versus 36.2%, p = 0.04 for PR). After adjusting for warmth and systemic symptoms, nipple retraction was independently and significantly predictive of IBC (OR = 18.8, 95% CI: 9.6‐37.7). For the first time, this population-based study confirmed what hospital-based and anecdotal reports sug

An update on inflammatory breast cancer

Inflammatory breast cancer is one of the most aggressive forms of breast cancer. Once considered to be a uniformly fatal disease, treatment of this entity has evolved significantly over the last two decades. In this article, we review the epidemiology, pathology, biologic underpinnings, radiologic advances, and treatment modalities for inflammatory breast cancer. Updates in surgical therapy, medical oncologic therapy and radiation therapy are reviewed. Emphasis is on cutting edge information regarding inflammatory breast cancer. The management of inflammatory breast cancer is best served by a multidisciplinary team. Continued research into molecular pathways and potential targets is imperative. Future clinical trials should include evaluation of conventional therapy with targeted therapies.

Locoregional Treatment Outcomes After Multimodality Management of Inflammatory Breast Cancer

The aims of this study were to determine outcomes for patients with inflammatory breast cancer (IBC) treated with multimodality therapy, to identify factors associated with locoregional recurrence, and to determine which patients may benefit from radiation dose escalation. We retrospectively reviewed 256 consecutive patients with nonmetastatic IBC treated at our institution between 1977 and 2004. The 192 patients who were able to complete the planned course of chemotherapy, mastectomy, and postmastectomy radiation had significantly better outcomes than the 64 patients who did not. The respective 5-year outcome rates were: locoregional control (84% vs. 51%), distant metastasis-free survival (47% vs. 20%), and overall survival (51% vs. 24%) (p < 0.0001 for all comparisons). Univariate factors significantly associated with locoregional control in the patients who completed plan treatment were response to neoadjuvant chemotherapy, surgical margin status, number of involved lymph nodes, and use of taxanes. Increasing the total chest-wall dose of postmastectomy radiation from 60 Gy to 66 Gy significantly improved locoregional control for patients who experienced less than a partial response to chemotherapy, patients with positive, close, or unknown margins, and patients <45 years of age. Patients with IBC who are able to complete treatment with chemotherapy, mastectomy, and postmastectomy radiation have a high probability of locoregional control. Escalation of postmastectomy radiation dose to 66 Gy appears to benefit patients with disease that responds poorly to chemotherapy, those with positive, close, or unknown margin status, and those <45 years of age.

The Medical Treatment of Inflammatory Breast Cancer

The multidisciplinary management of inflammatory breast cancer (IBC) includes neoadjuvant systemic chemotherapy, surgery, radiotherapy, and, in hormone receptor-positive disease, hormonal therapy. The use of induction chemotherapy with anthracyclines and taxanes somewhat improved the prognosis and local control of patients with IBC compared to local modalities alone. Improved understanding of the biological features of the disease has allowed for the development of targeted therapies (eg, trastuzumab and lapatinib) that are changing the outcome of this aggressive disease.

Surgical Management of Inflammatory Breast Cancer

Multimodality therapy consisting of primary chemotherapy, mastectomy, and radiotherapy appears to offer the most favorable outcomes for patients with inflammatory breast carcinoma (IBC). Patients who respond well to chemotherapy are the best candidates for surgery; if response to chemotherapy is poor, radiotherapy should be undertaken before attempting surgery. The operative field must be wide enough to encompass all secondary skin changes, and every attempt should be made to assure negative margins. Breast-conserving surgery and sentinel lymph node biopsy are not appropriate for patients with IBC. However, there are no medical contraindications to breast reconstruction after mastectomy, although most clinicians prefer to wait until after the completion of radiotherapy before attempting this additional surgery.

Systemic Treatments for Inflammatory Breast Cancer

Inflammatory breast cancer is rare but represents the most aggressive and lethal form of locally advanced breast cancer. The management of inflammatory breast cancer has evolved substantially over the last 40 years; current multimodality therapy regimens combine chemotherapy, surgery, and radiation. While identification of the optimal combination of these traditional therapies remains a goal, novel targeted therapies that have recently become available promise improved responses and survival. In this review, we discuss some recent developments in the use of systemic therapies for inflammatory breast cancer.

The Role of P53 Mutations As A Prognostic Factor and Therapeutic Target In Inflammatory Breast Cancer

Inflammatory breast cancer is a rare but lethal form of locally advanced breast cancer. Despite improvements in survival with the advent of multidisciplinary treatment regimens, 5-year survival rates remain disappointing, at approximately 30%. Numerous molecular markers have been investigated for their potential as useful prognostic and predictive markers of treatment response that would impact on the management of inflammatory breast cancer. This review discusses the current status of p53 mutations both as a prognostic marker and as a potential target for directed therapies.

Update on inflammatory breast cancer

Inflammatory breast cancer (IBC) is both the least frequent and the most severe form of epithelial breast cancer. The diagnosis is based on clinical inflammatory signs and is reinforced by pathological findings. Significant progress has been made in the management of IBC in the past 20 years. Yet survival among IBC patients is still only one-half that among patients with non-IBC. Identification of the molecular determinants of IBC would probably lead to more specific treatments and to improved survival. In the present article we review recent advances in the molecular pathogenesis of IBC. A more comprehensive view will probably be obtained by pan-genomic analysis of human IBC samples, and by functional in vitro and in vivo assays. These approaches may offer better patient outcome in the near future.

Update on the management of inflammatory breast cancer.

Inflammatory breast cancer (IBC) is the most aggressive manifestation of primary breast carcinoma, with the clinical and biological characteristics of a rapidly proliferating disease. The multidisciplinary management of IBC has changed in the past 3 decades and is presently clearly outlined in sequence, with preoperative or neoadjuvant chemotherapy representing the mainstay of treatment. Anthracyclines and taxanes are the most effective cytotoxic agents in the management of primary breast cancer and should be the standard of treatment for women with IBC. Locoregional treatment includes radiotherapy with or without surgery and continues to play a major role after appropriate medical treatment. The many investigations into the particular molecular determinants of IBC development have provided several interesting new therapeutic targets. Combination regimens that include angiogenic modulators, farnesyl transferase inhibitors, and p53 modulators hold great promise in the medical management of IBC. Future therapeutic approaches should focus on these discoveries so that we can improve the overall prognosis for women with IBC.