title: Exclusive alternating chemotherapy and radiotherapy in nonmetastatic inflammatory breast cancer: 20 years of follow-up.
abstract: BACKGROUND
  Locoregional treatment of inflammatory breast cancer (IBC) is crucial because local relapses may be highly symptomatic and are commonly associated with distant metastasis. With a median follow-up of 20 years, we report here the long-term results of a monocentric clinical trial combining primary chemotherapy (CT) with a schedule of anthracycline-based CT and an alternating split-course of radiotherapy (RT*CT) without mastectomy.
  
  
  METHODS
  From September 1983 to December 1989, 124 women with nonmetastatic IBC (T4d M0) were treated with three cycles of primary AVCMF chemotherapy (anthracycline, vincristine, cyclophosphamide, methotrexate, and 5-fluorouracil) and then an alternating RT*CT schedule followed by three cycles of FAC. Hormonal therapy was systematically administered: ovarian irradiation (12 Gy in four fractions) or tamoxifen 20 mg daily.
  
  
  RESULTS
  Local control was achieved in 82% of patients. The 10- and 20-year local relapse rates were 26% and 33%, respectively, but only 10% of locally controlled cases were not associated with concurrent distant metastasis. The 10- and 20-year overall survival rates were 39% and 19%, respectively. Severe fibrosis occurred in 54% of patients, grade 3 brachial plexus neuropathy in 4%, grade 2 pneumonitis in 9%. Grade 1, 2 and 3 cardiac toxicity was observed in 3.8%, 3.8% and 1.2% of cases respectively.
  
  
  CONCLUSIONS
  This combined regimen allowed good long-term local control without surgery. Survival rates were similar to those obtained with conventional regimens (primary chemotherapy, total mastectomy, and adjuvant radiotherapy). Since IBC continues to be an entity with a dismal prognosis, this approach, safely combining preoperative or postoperative radiation therapy and systemic treatments, should be reassessed when suitable targeted agents are available.
authors.affiliation: Department of Radiation Oncology, Breast Unit, Institut Gustave Roussy, Villejuif, France. bourgier@igr.fr
authors.forename: Céline
authors.initials: C
authors.lastname: Bourgier
authors.forename: Eduardo Lima
authors.initials: EL
authors.lastname: Pessoa
authors.forename: Ariane
authors.initials: A
authors.lastname: Dunant
authors.forename: Steve
authors.initials: S
authors.lastname: Heymann
authors.forename: Marc
authors.initials: M
authors.lastname: Spielmann
authors.forename: Catherine
authors.initials: C
authors.lastname: Uzan
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Mathieu
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Arriagada
authors.forename: Hugo
authors.initials: H
authors.lastname: Marsiglia
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D020516:Brachial Plexus Neuropathies / Q000453:epidemiology / Q000473:pathology; 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 / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D019583:Dose Fractionation, Radiation; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005355:Fibrosis; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006321:Heart / Q000528:radiation effects; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011832:Radiation Injuries / Q000473:pathology; D017564:Radiation Pneumonitis / Q000453:epidemiology / Q000473:pathology; D015996:Survival Rate; D013629:Tamoxifen / Q000008:administration & dosage; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D013629:Tamoxifen; D015251:Epirubicin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate