Breast Cancer Inflammatory

Epidemiology

General

Risk Factors

Presentation and Evaluation

  • Local advance and neglected (> 3 mo history) breast cancer is not likely to be Inflammatory breast cancer.
  • it is a both clinical and pathologic diagnosis
    • erythema, ridging and peau d'orange associated with rapid tumor growth
    • dermal lymphatic invasion is not required by helpful.

Treatment

Initial Treatment

  • Neoadjuvant chemotherapy with AC or FAC followed by a taxane

Evaluation of response

  • Post neoadjuvant chemotherapy is evaluated using mammography and ultrasonography
  • CR is total clinical resolution
  • PR is 50% reduction in tumor mass
  • NR is all else

PR or CR

  • Surgery (ie. mastectomy w/ ALND)
  • XRT
  • TAM or AI if ER+

< PR

  • XRT
  • TAM or AI if ER+

Radiation Technique

Dose and Field

  • Initial Field: 51 Gy in 43 fractions (1.5 Gy BID)
    • Skin (bolus 3-5 mm) until sufficient reaction occurs
    • Internal mammary nodes
    • Supraclavicular fossa and level III axilla
  • Chest Wall Boost (not scar boost): 15 Gy 10 fractions (1.5 Gy BID)
    • include at minimum 4-5 cm on each side of the sca

Outcome

Prognostic Factors

No Chemotherapy

  • Fewer than 5% of patients treated with surgery and/or radiotherapy survived past 5 years, and the expected median survival time for such patients was less than 15 months.[4]
  • Local recurrence rates with surgery and/or radiotherapy were also high at approximately 50%[5]

doxorubicin

  • doxorubicin-based chemotherapy improved the 5-year survival rates to 30% to 40%.[5]
  • no significant improvement in local control.

combined modality

  • combining neoadjuvant chemotherapy, mastectomy, and postmastectomy hyperfractionated radiation, investigators have reported locoregional control rates of 85%.
  • OS-10 26.7% according to SEER data this compare to 44.8% OS-10 for non-inflammatory breast cancer.[7]

Summary

Studies

Bibliography
1. Cox J, Ang K. Radiation Oncology: rationale Technique Results. 8th ed. New York: Mosby, 2003.
2. Gunderson L, Tepper J: Clinical Radiation Oncology. 2nd ed. China: Elsevier 2007.
3. Devita V, Hellman S, Rsenberg S: Cancer: Principles and practice of Oncology. 7th ed. Philadelphia: Lippincott, 2005.
4. F. Bozzetti, R. Saccozzi, M. De Lena and B. Salvadori, Inflammatory cancer of the breast: analysis of 114 cases, J Surg Oncol 18 (1981), 355–361.
5. Ian J. Bristol and Thomas A. Buchholz, Inflammatory Breast Cancer: Current Concepts in Local Management. Breast Disease 22 (2005,2006) 75–83.
6. Z. Liao, E.A. Strom, A.U. Buzdar et al., Locoregional irradiation for inflammatory breast cancer: effectiveness of dose escalation in decreasing recurrence, Int J Radiat Oncol Biol Phys 47 (2000), 1191–200.
7. Chang S, Parker SL, Pham T, Buzdar AU, Hursting SD. Inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program of the National Cancer Institute, 1975-1992. Cancer. 1998 Jun 15;82(12):2366-72.
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