Locoregional treatment outcomes after multimodality management of inflammatory breast cancer.
OBJECTIVE
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.


METHODS
We retrospectively reviewed 256 consecutive patients with nonmetastatic IBC treated at our institution between 1977 and 2004.


RESULTS
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.


CONCLUSIONS
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.
Bristol
Ian J
IJ
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Woodward
Wendy A
WA
Strom
Eric A
EA
Cristofanilli
Massimo
M
Domain
Delora
D
Singletary
S Eva
SE
Perkins
George H
GH
Oh
Julia L
JL
Yu
Tse-Kuan
TK
Terrefe
Welela
W
Sahin
Aysegul A
AA
Hunt
Kelly K
KK
Hortobagyi
Gabriel N
GN
Buchholz
Thomas A
TA
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011832:Radiation Injuries / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome