title: Inflammatory Breast Cancer: Patterns of Failure and the Case for Aggressive Locoregional Management.
abstract: BACKGROUND
  Inflammatory breast cancer (IBC) is a rare and aggressive subtype. This study analyzes the patterns of failure in patients with IBC treated at our institution.
  
  
  METHODS
  We retrospectively analyzed the records of 227 women with IBC presenting between 1997 and 2011. Survival analysis was used to calculate overall survival (OS) and disease-free survival. Competing risk analysis was used to calculate locoregional recurrence (LRR).
  
  
  RESULTS
  A total of 173 patients had locoregional-only disease at presentation (non-MET). Median follow-up in the surviving patients was 3.3 years. Overall, 132 (76.3 %) patients received trimodality therapy with chemotherapy, surgery, and radiotherapy. Three-year OS was 73.1 % [95 % confidence interval (CI) 64.9-82.4]. Cumulative LRR was 10.1, 16.9, and 21.3 % at 1, 2, and 3 years, respectively. No variable was significantly associated with LRR. Fifty-four patients had metastatic disease at presentation (MET). Median follow-up in the surviving patients was 2.6 years. Three-year OS was 44.3 % (95 % CI 31.4-62.5). Twenty-four (44.4 %) patients received non-palliative local therapy (radiotherapy and/or surgery). For these patients, median OS after local therapy was 2 years. Excluding six patients who received local therapy for symptom palliation, the crude incidence of locoregional progression or recurrence (LRPR) was 17 % (4/24) for those who received local therapy compared with 57 % (13/23) for those who did not.
  
  
  CONCLUSIONS
  For non-MET patients, LRR remains a problem despite trimodality therapy. More aggressive treatment is warranted. For MET patients, nearly 60 % have LRPR with systemic therapy alone. Local therapy should be considered in the setting of metastatic disease to prevent potential morbidity of progressive local disease.
authors: Harvard Radiation Oncology Program, Boston, MA, USA.
authors: Laura E G
authors: LE
authors: Warren
authors: Hao
authors: H
authors: Guo
authors: Meredith M
authors: MM
authors: Regan
authors: Faina
authors: F
authors: Nakhlis
authors: Eren D
authors: ED
authors: Yeh
authors: Heather A
authors: HA
authors: Jacene
authors: Judi
authors: J
authors: Hirshfield-Bartek
authors: Beth A
authors: BA
authors: Overmoyer
authors: Jennifer R
authors: JR
authors: Bellon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000737:chemistry / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000628:therapy*; D008207:Lymphatic Metastasis; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018714:Radiotherapy, Adjuvant; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human