Management of locally advanced carcinoma of the breast: II. Inflammatory carcinoma

Abstract

Background. Inflammatory carcinoma of the breast has been associated with a poor prognosis. Several therapeutic approaches have been under investigation in an effort to improve outcome.Methods. This is a retrospective analysis of 179 patients with histologically confirmed inflammatory carcinoma of the breast: 33 treated with irradiation alone, 35 with combined irradiation and chemotherapy, 25 with irradiation and surgery, and 86 with a combination of three modalities.Results. The 5-year disease free survival (DFS) rates were 40% for patients treated with three modalities, 24% for those treated with irradiation and surgery, and 6% for those treated with irradiation alone or in combination with chemotherapy without a surgical procedure. The 10-year DFS rates were 35' /0, 24%, and O%, respectively. Cause specific survival (CSS) curves closely follow the same trends. A clearly superior locoregional tumor control was observed in patients who underwent a surgical procedure: 79% with three modalities, 76% with irradiation and surgery, and only 30% with irradiation alone or in combination with chemotherapy. Distant metastasis occurred in 57% of the group treated with triple-modality therapy, 60% of those treated with irradiation plus surgery, and 85% of the patients treated with irradiation alone or in combination with chemotherapy. There was no significant correlation between the type of mastectomy or doses of irradiation and locoregional tumor control or survival. The significant morbidity of the trimodal ther-

High-dose chemotherapy with peripheral blood stem cell support for stage IIIB inflammatory carcinoma of the breast

“…1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Increased dose intensity without stem cell support has been associated with improved outcomes in some 9 but not other studies. 12 There is limited information concerning the effects of HDC with stem cell support in patients with IBC.…”

“…The currently favored approach to the treatment of locally advanced breast cancer is to administer neoadjuvant chemotherapy before surgery in order to optimize surgical resection and local control. 8 The exact contribution of neoadjuvant, compared to adjuvant chemotherapy, to local control or the prevention of distant relapses is not clear. 45 In the current study there were four local-regional relapses, 1/15 (7%) in the adjuvant group and 3/41 (7%) in the neoadjuvant group.…”

“…23,30,31,43,44 However, there have been reports of EFS of 40-56% at 4-5 years following neoadjuvant chemotherapy delivered without stem cell support. [8][9][10] An obvious approach would be to perform a randomized trial comparing HDC with stem cell support to intensive neoadjuvant chemotherapy without stem cell support. Since IBC comprises only 1-4% of all breast cancer patients, randomized trials comparing conventional to HDC would be difficult to perform even by large cooperative groups.…”

“…1,2 The usual sequence of treatment involves induction chemotherapy followed by surgery, radiation therapy, further chemotherapy and hormonal therapy resulting in 5 year event-free survivals (EFS) of approximately 30%. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of induction chemotherapy and local-regional radioCorrespondence: Dr CD Buckner, Response Oncology, Inc., 600 Broadway, Suite 112, Seattle, WA 98122, USA Received 18 January 1999; accepted 15 April 1999 therapy has decreased local progression of disease but the majority of patients relapse at distant sites making eradication of microscopic metastatic disease the major challenge.The potential value of high-dose chemotherapy (HDC) with hematopoietic stem cell support in patients with operable high-risk stage II-III non-inflammatory breast cancer has been reported. [19][20][21][22][23][24][25][26] Evaluation of HDC with stem cell support in patients with IBC is a logical extension of these studies.…”

Fungating Metastatic Breast Cancer, a Challenging Case Report of Bleeding Control and Palliative Wound Care

“…As sometimes happens, patients elect to go with different means of treatment and not the mastectomy with lymph node dissection, radiation, and chemotherapy that is the standard of care. 3,4,8,9,10,11,12,13 Even though the patient elected not to attempt the full surgery, there are still surgical options that could have helped her quality of life and are important to consider. Wound care can be curative for many different wounds but can also greatly improve the quality of life that is present.…”