Concomitant intensive chemoradiotherapy induction in non-metastatic inflammatory breast cancer: long-term follow-up

Abstract

The aim of this study was to evaluate with a long follow-up the efficacy of concomitant chemoradiotherapy in non-metastatic inflammatory breast cancer (IBC) and to evaluate the breast conservation rate. Between 1990 and 2000, 66 non-metastatic patients with IBC were treated with chemotherapy and concomitant irradiation. The induction chemotherapy consisted of epirubicine, cyclophosphamide and vindesine, in association with split-course bi-fractionated irradiation to a total dose of 65 Gy with concomitant cisplatin and 5-fluorouracil. Maintenance chemotherapy consisted of high-dose methotrexate and six cycles of epirubicine, cyclophosphamide and fluorouracil. Hormonal treatment was given if indicated. Mastectomy was not systemic. Among 65 evaluable patients, 57 (87.6%) achieved a complete clinical response and had a breast conservation. Only six loco regional relapses were noted in six patients with a delay of 20 months and with concomitant metastatic dissemination in four cases. Median disease-free survival (DFS) was 28 months. Median overall survival (OS) was 63 months and median follow-up was 55.5 months. Induction chemotherapy and concomitant irradiation is feasible in patients with IBC, permitting a breast conservation with a high rate of local control with an OS comparable to that of the best recent series. British Journal of Cancer (2007) (Chang et al, 1998). Its incidence has doubled over the last 20 years (Hance et al, 2005).Despite advances in treatment with induction chemotherapy regimens, disease-free survival (DFS) and overall survival (OS) remain unsatisfactory with a 30 -50% 5-year survival in the largest studies (Anderson et al, 2003;Cristofanilli et al, 2003;Somlo et al, 2004;Lerebours et al, 2005). The role of surgery remains controversial even though it is often used in protocols (Schafer et al, 1987;De Boer et al, 2000). The achievement of pathologic response to induction chemotherapy is an excellent indicator of prolonged (DFS) and (OS) (Ueno et al, 1997). This is achieved in less than 30% of patients (Chevallier et al, 1993).Based on these results, we conducted a protocol combining the most active drugs such as anthracycline with radiotherapy as the major local treatment as the initial treatment without mastectomy.We report the long-term efficacy of this protocol in 66 patients with non-metastatic IBC. MATERIALS AND METHODSBetween 1990 and 2000, 66 consecutive patients with nonmetastatic IBC received treatment. All the patients were examined by a multidisciplinary team and gave their written informed consent for participation. Eligibility included clinical and/or pathological criteria for IBC as defined by Haagensen (Haagensen, 1971). Non-metastatic IBC was defined by negative thoracoabdominal scan and bone scan.The protocol was described previously (Tubiana-Mathieu et al, 2001) as shown in Figure 1: three cycles with a 28-day delay associated in day 1, epirubicine (E) (50 mg m À2 ), cyclophosphamide (C) (350 mg m À2 ) and vindesine (V) (2 mg m À2 ), and CDDP (10 mg m À2 day À1 ), 5-FU (500 ...

Management of Inflammatory Breast Cancer After Neoadjuvant Chemotherapy

“…However, despite combined modality treatment, IBC continues to have a very poor prognosis and further efforts are required to improve systemic control to eradicate occult microscopic disease by incorporating the use of anthracycline-based chemotherapy (10,30), taxanes (36), high-dose chemotherapy (23,35,37,38), and new agents (39)(40)(41)(42)(43)(44)(45).…”

Taxa de sobrevida na mulher com câncer de mama: estudo de revisão

“…The publications originated from 20 countries: Korea (six studies), [8][9][10][11][12][13] Japan (five studies), [14][15][16][17][18] Brazil (four studies), 3,[19][20][21] Canada (three studies), [22][23][24] United States (three studies), [25][26][27] Italy (three studies), [28][29][30] Switzerland (three studies), [31][32][33] France (two studies), 34,35 China (one study), 36 Singapore and Sweden (one study, study performed in both countries), 37 Scotland (one study), 38 Spain (one study), 39 Finland (one study), 40 India (one study), 41 England (two studies), 42,45 Mexico (one study), 43 Poland (one study), 44 and the Netherlands (one study). 46 From the aim established for this study, the variables to be investigated were defined: the study design, study site/country, number of subjects, age of the subjects, five year survival rate, disease-free five year survival rate, factors that contribute to the increase in survival rates.…”

Lessons Learned from an Unusual Case of Inflammatory Breast Cancer

“…12 Other studies have reported 2-, 10-, and 20-year overall survival rates of 82%, 32%-38%, and 19%, respectively using various regimens. [13][14][15][16] Although radiotherapy retreatment is common across many types of cancer, median time between retreatment episodes has been observed to be longest in breast cancer (12.5 months). 17 As our patient was treated several years prior with radiotherapy for DCIS, the need for repeat radiotherapy adds complexity to her care.…”