Long-term Follow-up of Breast-conserving Therapy in Patients with Inflammatory Breast Cancer Treated with Neoadjuvant Chemotherapy

Abstract

Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Currently, multimodality treatment is recommended, but the optimal surgical management has not been fully elucidated. In this study, we investigated the long-term outcomes of using breast-conserving therapy in patients with IBC undergoing neoadjuvant chemotherapy (NAC). Twenty-four patients with IBC were treated from 2002 to 2006. NAC was initiated with doxorubicin and cyclophosphamide followed by paclitaxel. In addition, HER2/neu-positive patients received trastuzumab, whereas HER2/neu-negative patients received bevacizumab. Clinical response was assessed by dynamic contrast-enhanced magnetic resonance imaging before surgery and pathologic response after surgery. A partial mastectomy with sentinel lymph node biopsy and/or axillary lymph node dissection or a modified radical mastectomy was performed based on the surgeon's recommendations and patient's preference. All patients received adjuvant radiation. Of the 24 patients, seven (29%) underwent a partial mastectomy and 17 (71%) underwent a mastectomy. The overall survival rate for partial mastectomy and for mastectomy patients was 59 and 57 per cent ( P = 0.49), respectively, at a median follow-up of 60 months (range, 48 to 92 months). Breast-conserving therapy can be considered in a selected group of patients who demonstrate a good response to NAC.

Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

“…MR imaging is routinely used to monitor treatment response to neoadjuvant chemotherapy. Studies have suggested a correlation between various MR imaging parameters, such as baseline morphologic features, functional tumor volume, background parenchymal enhancement, and pCR in patients with HER2-positive breast cancer (23)(24)(25)(26)(27). These studies show good results, with some suggestion that MR imaging is more accurate in predicting pCR in ER-negative tumors (28).…”

The Impact of Locoregional Therapy in Nonmetastatic Inflammatory Breast Cancer: A Population-Based Study

“…Our finding that partial mastectomy is associated with poorer survival contrasts with two small reports on breast conservation therapy in women with IBC. Bonev and colleagues [ 11 ] retrospectively analyzed a series of 24 patients with IBC and found no significant difference in overall survival at median follow-up of 60 months between women who underwent partial mastectomy versus total mastectomy following neoadjuvant chemotherapy (overall survival 59% versus 57%, 0.49). Similarly, in a retrospective single-institution analysis, Brzezinska and colleagues [ 12 ] found that 35 women with IBC treated with breast conservation surgery had similar rates of locoregional control and survival compared with those treated with mastectomy.…”

“…Whether the addition of locoregional therapy to anthracycline-based chemotherapy impacts survival in IBC remains controversial, especially the extent of surgery [ 10 ]. Several authors [ 11 , 12 ] have reported similar survival rates in small cohort studies with patients who underwent breast conserving surgery when compared to patients who underwent total mastectomy after preoperative systemic therapy and have questioned whether IBC is an absolute contraindication to breast conservation therapy. However, these reports are from single institutions and have a small sample size.…”

International Consensus on the Clinical Management of Inflammatory Breast Cancer from the Morgan Welch Inflammatory Breast Cancer Research Program 10th Anniversary Conference

“…This cohort represents a selected subset of patients diagnosed with IBC with low disease burden. Case selection is likely to have a bearing on several other reported series where a breast conservation approach was used 40 , 41 . In large retrospective series the outcome after a conservative approach appears inferior, although again the caveats of retrospective studies are acknowledged 42 .…”