title: Inflammatory breast cancer in Tunisia in the era of multimodality therapy.
abstract: BACKGROUND
  This study aimed to identify prognostic factors for outcome in Tunisian patients with nonmetastatic inflammatory breast cancer (IBC) receiving multimodality therapy.
  
  
  METHODS
  From 1994 to 2000, 100 patients with nonmetastatic IBC were reviewed. Patients underwent neo-adjuvant chemotherapy including anthracyclines (99%), then mastectomy (93%) when feasible, radiotherapy (83%) and adjuvant chemotherapy (84%). Sixty patients (60%) had hormone therapy.
  
  
  RESULTS
  Median age at diagnosis was 44 years (range 23-71). Seventy patients had premenopausal status (70%). Ten cases occurred during pregnancy (10%). Body mass index indicated overweight or obesity in 76 patients (76%). After neo-adjuvant chemotherapy, pathologic complete response (pCR) rate was 20%. Median time of follow-up for surviving patients was 44 months. Median progression-free survival (PFS) was 19 months and overall survival (OS) 30 months. Factors associated with improved survival were no pregnancy (P = 0.0095), estrogen receptor positivity (P = 0.028), tumor size <5 cm (P = 0.021), clinical complete response (cCR) (P = 0.022), pCR (P = 0.011), negative nodes (P = 0.053) and hormone therapy (P < 0.001). In multivariate analysis, cCR, negative nodes and hormone therapy were independently associated with better OS and PFS. Factors predictive to pCR were age >45 years, negative nodes and cCR.
  
  
  CONCLUSIONS
  Tunisian patients with IBC have particular epidemiologic characteristics, with earlier disease and context of overweight and obesity, but prognostic factors are similar to those reported in the literature. Hormone therapy seems to improve patient outcome.
authors.affiliation: Department of Medical Oncology, Salah Azaiz Institute, Tunis, Tunisia. labidi@lyon.fnclcc.fr
authors.forename: S I
authors.initials: SI
authors.lastname: Labidi
authors.forename: K
authors.initials: K
authors.lastname: Mrad
authors.forename: A
authors.initials: A
authors.lastname: Mezlini
authors.forename: M Ayadi
authors.initials: MA
authors.lastname: Ouarda
authors.forename: J D
authors.initials: JD
authors.lastname: Combes
authors.forename: M
authors.initials: M
authors.lastname: Ben Abdallah
authors.forename: K
authors.initials: K
authors.lastname: Ben Romdhane
authors.forename: P
authors.initials: P
authors.lastname: Viens
authors.forename: F
authors.initials: F
authors.lastname: Ben Ayed
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology; D015410:Mastectomy, Extended Radical; D008875:Middle Aged; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D014416:Tunisia / Q000453:epidemiology