title: Chemotherapy and concomitant irradiation in inflammatory breast cancer.
abstract: The purpose of this study was to evaluate the efficacy of concurrent chemotherapy and irradiation in inflammatory breast cancer (IBC). Between January 1990 and December 1998, forty-eight non-metastatic patients with clinical or occult IBC were treated with chemotherapy and irradiation. The induction chemotherapy consisted of epirubicin, cyclophosphamide and vindesin, in association with split-course bi-fractionated irradiation to a total dose of 65 Gy with concomitant cisplatin and fluorouracil. Maintenance chemotherapy consisted of high-dose methotrexate and 6 cycles of epirubicin, cyclophosphamide and fluorouracil Hormonal treatment was given routinely but mastectomies were not routinely performed. A high rate of locoregional control was obtained in 47 evaluable patients of whom 93.6 % achieved a complete clinical response. Three patients had locoregional relapses, always with concomitant metastatic dissemination. In 47 patients, 21 developed metastatic dissemination with a median delay of 23 months. Median disease-free survival (DFS) was 45 months. Median overall survival (OS) has not yet been reached after a median follow-up of 44.5 months. The 3-year DFS rate was 53 % and the 3-year OS rate was 71 %. Toxicity was mainly hematological. During the induction therapy, grade 3 or 4 neutropenia occurred in 54 % of patients, grade 3 or 4 thrombocytopenia in 23 % and grade 3 or 4 anemia in 8 %. The administration of induction chemotherapy and concomitant irradiation is feasible in patients with IBC. The hematological toxicity of this treatment approach is significant but nevertheless, the treatment achieves a high degree of locoregional control and improved survivaL
authors.affiliation: Department of Medical Oncology and Radiotherapy CHU DUPUYTREN, Limoges, France. oncologie@chu-limoges.fr
authors.forename: N
authors.initials: N
authors.lastname: Tubiana-Mathieu
authors.forename: C
authors.initials: C
authors.lastname: Lejeune
authors.forename: P
authors.initials: P
authors.lastname: Bonnier
authors.forename: D
authors.initials: D
authors.lastname: Genet
authors.forename: D J
authors.initials: DJ
authors.lastname: Adjadj
authors.forename: J F
authors.initials: JF
authors.lastname: Berda
authors.forename: X
authors.initials: X
authors.lastname: Muracciole
authors.forename: F
authors.initials: F
authors.lastname: Delaby
authors.forename: P
authors.initials: P
authors.lastname: Clavere
authors.forename: A
authors.initials: A
authors.lastname: Benyoub
authors.forename: B
authors.initials: B
authors.lastname: Rhein
authors.forename: B
authors.initials: B
authors.lastname: Juin
authors.forename: L
authors.initials: L
authors.lastname: Piana
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D015993:Life Tables; D008593:Menopause; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use; D013924:Thrombophlebitis / Q000209:etiology; D016896:Treatment Outcome; D014751:Vindesine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen; D007987:Gonadotropin-Releasing Hormone; D015251:Epirubicin; D003520:Cyclophosphamide; D014751:Vindesine; D005472:Fluorouracil; D008727:Methotrexate