Locoregional Outcomes of Inflammatory Breast Cancer Patients Treated With Standard Fractionation Radiation and Daily Skin Bolus in the Taxane Era

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
International journal of radiation oncology, biology, physics (Impact Factor: 4.26). 10/2009; 77(4):1105-12. DOI: 10.1016/j.ijrobp.2009.06.042
Source: PubMed


To assess locoregional outcomes of inflammatory breast cancer (IBC) patients who received standard fractionation radiation with daily skin bolus and taxanes as part of combined-modality therapy (CMT).
We retrospectively reviewed the charts of 107 patients diagnosed with IBC between January 1995 and March 2006 who presented to our department for adjuvant radiation therapy (RT).
All patients received chemotherapy (95% anthracycline and 95% taxane), modified radical mastectomy, and RT to the chest wall and regional lymphatics using standard fractionation to 50 Gy and daily skin bolus. The RT to the chest wall was delivered via electrons (55%) or photons (45%) in daily fractions of 180 cGy (73%) or 200 cGy (27%). Scar boost was performed in 11%. A majority (84%) of patients completed the prescribed treatment. Median follow-up was 47 months (range, 10-134 months). Locoregional control (LRC) at 3 years and 5 years was 90% and 87%, respectively. Distant metastases-free survival (DMFS) at 3 years and 5 years was 61% and 47%, respectively.
Excellent locoregional control was observed in this population of IBC patients who received standard fractionation radiation with daily skin bolus and taxanes as part of combined-modality therapy. Distant metastases-free survival remains a significant therapeutic challenge.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Our retrospective analysis compared the effectiveness of conventional antracycline-containing protocols (A+) and docetaxel/epirubicine (TE) as primary systemic chemotherapies (PSCT) for inflammatory breast cancer (IBC). Seventy IBC patients received either A + (n = 48) or TE (n = 22) as PSCT. The objective clinical response and clinical benefit rate of treated patients were 54.3% (A+: 54,2% vs. TE: 54,5%; p = 0,28) and 92.8% (A+: 91,7% vs. TE: 95,5%; p = 0,57), respectively. The clinical complete response rate (cCR) was 23.2% (A+: 27,1% vs. TE:4,5%; χ 2 = 4,79; p = 0,03) with 7.14% (A+: 10,4% vs. TE:0%; χ 2 = 2,47; p = 0,12) of pathological complete responses (pCR). The median progression free (PFS)/local progression free (LPFS)/overall survival (OS) was 2.0/5.4/4.0 years, respectively. Patients achieving cCR had a tendency for better survival parameters than patients with less than cCR. Response rates or survival data were not statistically different in the two chemotherapy (CT) treatment groups. The survival was not influenced by the number of CT cycles in either protocols. In this set of patients, the clinical efficacy of the two alternative primary systemic chemotherapies (A + and TE) is equivalent in the treatment of inflammatory breast cancer (IBC), despite of the significant difference in favour of A + noticed in CRs. Six cycles of CT could be enough for patients achieving CR, however sequential pre- and/or postoperative CT with non cross-resistant drugs should be considered for non-responders.
    Full-text · Article · Dec 2010 · Pathology & Oncology Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: Locoregional treatment of inflammatory breast cancer (IBC) is crucial because local relapses may be highly symptomatic and are commonly associated with distant metastasis. With a median follow-up of 20 years, we report here the long-term results of a monocentric clinical trial combining primary chemotherapy (CT) with a schedule of anthracycline-based CT and an alternating split-course of radiotherapy (RT*CT) without mastectomy. From September 1983 to December 1989, 124 women with nonmetastatic IBC (T4d M0) were treated with three cycles of primary AVCMF chemotherapy (anthracycline, vincristine, cyclophosphamide, methotrexate, and 5-fluorouracil) and then an alternating RT*CT schedule followed by three cycles of FAC. Hormonal therapy was systematically administered: ovarian irradiation (12 Gy in four fractions) or tamoxifen 20 mg daily. Local control was achieved in 82% of patients. The 10- and 20-year local relapse rates were 26% and 33%, respectively, but only 10% of locally controlled cases were not associated with concurrent distant metastasis. The 10- and 20-year overall survival rates were 39% and 19%, respectively. Severe fibrosis occurred in 54% of patients, grade 3 brachial plexus neuropathy in 4%, grade 2 pneumonitis in 9%. Grade 1, 2 and 3 cardiac toxicity was observed in 3.8%, 3.8% and 1.2% of cases respectively. This combined regimen allowed good long-term local control without surgery. Survival rates were similar to those obtained with conventional regimens (primary chemotherapy, total mastectomy, and adjuvant radiotherapy). Since IBC continues to be an entity with a dismal prognosis, this approach, safely combining preoperative or postoperative radiation therapy and systemic treatments, should be reassessed when suitable targeted agents are available.
    No preview · Article · Jan 2011 · International journal of radiation oncology, biology, physics
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Postmastectomy radiotherapy bolus is heterogenous, with little evidence to guide clinical practise. This study explores the effect of chest wall bolus technique on chest wall recurrence. This was a retrospective cohort study of 254 patients treated with adjuvant postmastectomy radiotherapy between 1993 and 2003. Patient and treatment characteristics including bolus details were extracted. Outcomes considered were treatment toxicities, treatment delivery, and local recurrence. In all, 143 patients received radiotherapy with whole chest wall bolus, 88 patients with parascar bolus, and 23 with no bolus. Twenty patients did not complete radiotherapy because of acute skin toxicity: 17 in the whole chest wall bolus group, 2 in the parascar bolus group, and 1 in the group not treated with bolus. On multivariate analysis, whole chest wall bolus and chemotherapy were found to be significant predictors for early cessation of radiotherapy resulting from acute skin toxicity. There were 19 chest wall failures: 13 in the whole chest wall bolus group, 4 in the parascar bolus group, and 2 in the no-bolus group. On multivariate analysis, lymphovascular invasion and failure to complete radiotherapy because of acute skin toxicity were associated with chest wall recurrence. From our results, parascar bolus and no bolus performed no worse than did whole chest wall bolus with regard to chest wall recurrence. However, bolus may have an impact on early cessation of radiotherapy caused by skin toxicity, which then may influence chest wall recurrence.
    Full-text · Article · Feb 2011 · International journal of radiation oncology, biology, physics
Show more

We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.