title: Prognostic indicators and survival in patients with stage IIIB inflammatory breast carcinoma after dose-intense chemotherapy.
abstract: OBJECTIVE
  To improve treatment outcome for patients presenting with inflammatory breast cancer (IBC), we have sequentially developed and tested single and tandem dose-intense chemotherapy regimens (DICT). Tumor- and treatment-related factors were analyzed to generate a prognostic model.
  
  
  METHODS
  Between May 1989 and April 2002, 120 patients received conventional-dose chemotherapy, surgery, and sequentially developed single- or tandem-cycle DICT. Disease- and treatment-specific features were subjected to univariate and multivariate analysis to correlate with outcome.
  
  
  RESULTS
  At a median follow-up of 61 months (range, 21 to 161 months), estimated 5-year relapse-free survival (RFS) and overall survival (OS) were 44% (95% CI, 34% to 53%) and 64% (95% CI, 55% to 73%), respectively. In an age-adjusted multivariate analysis, RFS was better in patients with estrogen receptor (ER)/progesterone receptor (PR)-positive tumors (P =.002), for patients with fewer than four involved axillary nodes before DICT (P =.01), and in patients treated with radiation therapy (P =.001) and tandem DICT (P =.049). OS was improved in patients with ER/PR-positive tumors (P =.002), in those with fewer than four involved axillary nodes before DICT (P =.03), and in patients treated with radiation therapy (P =.002).
  
  
  CONCLUSIONS
  This retrospective analysis suggests that either single or tandem DICT can be administered safely and may benefit selected patients with stage IIIB IBC. Those with receptor-negative IBC and with four or more involved axillary nodes before DICT need improved neoadjuvant and postadjuvant intensification therapy. A prospective randomized trial of single versus tandem DICT would be required to confirm the potential benefit of tandem DICT in the setting of IBC.
authors.affiliation: Department of Medical Oncoilogy and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA. gsomlo@coh.org
authors.forename: George
authors.initials: G
authors.lastname: Somlo
authors.forename: Paul
authors.initials: P
authors.lastname: Frankel
authors.forename: Warren
authors.initials: W
authors.lastname: Chow
authors.forename: Lucille
authors.initials: L
authors.lastname: Leong
authors.forename: Kim
authors.initials: K
authors.lastname: Margolin
authors.forename: Robert
authors.initials: R
authors.lastname: Morgan
authors.forename: Stephen
authors.initials: S
authors.lastname: Shibata
authors.forename: Peiguo
authors.initials: P
authors.lastname: Chu
authors.forename: Stephen
authors.initials: S
authors.lastname: Forman
authors.forename: Dean
authors.initials: D
authors.lastname: Lim
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Twardowski
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Weitzel
authors.forename: Joseph
authors.initials: J
authors.lastname: Alvarnas
authors.forename: Neil
authors.initials: N
authors.lastname: Kogut
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schriber
authors.forename: Eleanor
authors.initials: E
authors.lastname: Fermin
authors.forename: Yun
authors.initials: Y
authors.lastname: Yen
authors.forename: Lloyd
authors.initials: L
authors.lastname: Damon
authors.forename: James H
authors.initials: JH
authors.lastname: Doroshow
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002140:California; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome