Multimodality therapy, with neoadjuvant chemotherapy followed by locoregional therapy consisting of surgery and radiotherapy has become the standard approach for treating patients with inflammatory breast cancer (IBC). Whilst improved response rates with the use of anthracycline and taxane based chemotherapies have been reported,r the sequence of agents is yet to be defined.
Single modality therapy for IBC has been associated with poorer outcomes, with 5 year survival rates ranging from 0-10% for mastectomy alone.r The combined local approach of surgery (mastectomy) and radiotherapy following neoadjuvant chemotherapy provides optimal locoregional control, however, minimal benefit has been shown in overall survival. Where there is suboptimal response to neoadjuvant chemotherapy, radiotherapy may be given preoperatively. If the patient is still inoperable, subsequent treatment will need to be individualized.r
Summary of outcomes supporting this protocol:
||No. of patients (Experimental/control)
|15 year DFS
||Ueno et al. 1997r
||Median f/up 89 months; neoadjuvant chemotherapy + RT and/or mastectomy + chemotherapy
|Locoregional control rates
||Bristol et alr
||84% vs 51% (p< 0.0011) multimodality vs treatment on case basis
||Median f/up 7-240 months; 75% (192) completed multimodality course of Chemotherapy+ mastectomy + RT vs 25% (64) unable to complete intended course and treatment according to particular case
||51% vs 24% (p<0.0001)
|Distant metastases free survival
||47% vs 20% (p<0.0001)
The SEER analysis by Dawood et alr of 828 women with IBC and 3476 women with non IBC locally advanced breast cancer (non IBC LABC), reported 2 year breast cancer specific survival rates of 84% (95% CI, 80-87%) and 91% (95% CI, 90-92%) among women with IBC and non IBC LABC respectively, with an absolute difference of 7% at 2 years. Women with IBC had a 43% increased risk of death from breast cancer when compared to patients with non IBC LABC (HR: 1.43; 95% CI, 1.10-1.86, p=0.008).
The use of breast conserving surgery in patients with IBC has been associated with poor cosmesis and limited data suggest that rates of local recurrence may be higher when compared with mastectomy.r