Treatment for Inflammatory Breast Cancer
This is a companion piece to yesterday's entry about inflammatory breast cancer (IBC). If you are reading this and missed yesterday's blog, do scroll down and read that first. The gist of today's piece, from MedWire, is the value of multi-modality treatment for this variant of breast cancer. Of course, frankly, we know that multi-modality therapies are often valuable in most breast cancers. What is different about this is the consistent use of radiation therapy after mastectomy and a bolus of radiation directly to the skin of the chest wall.
Combined-modality therapy effective for inflammatory breast cancer
Int J Radiat Oncol Biol Phys 2010;
Patients treated for inflammatory breast cancer (IBC) with taxane-containing chemotherapy and standard fractionation radiation with daily skin bolus have excellent locoregional control, US researchers report.
Over the past decade, IBC patients at the Memorial Sloan-Kettering Cancer Center (MSKCC) in New York have been treated in a consistent fashion with a combined-modality therapy. The treatment consists of anthracycline and taxane-containing chemotherapy, modified radical mastectomy (MRM), and radiotherapy to the chest wall and regional lymphatics using standard fractionation to 50 Gy with daily skin bolus.
In the present study, Shari Damast and colleagues from the MSKCC examined the locoregional outcomes resulting from their technique by retrospectively reviewing the medical charts of 107 patients with IBC who were treated in their department.
The researchers report that radiotherapy 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% of patients.
During a median follow-up of 47 months, 12 patients developed locoregional recurrence (LRR). The rate of locoregional control was 90% at 3 years and 87% at 5 years. The rate of distant metastasis-free survival at 3 years and 5 years was lower, at 61% and 47%,respectively.
All patients developed acute dermatitis, with 88% experiencing a Grade 2 or higher skin reaction. Nonetheless, the majority (84%) of patients completed the prescribed treatment.
Unadjusted analyses revealed that the risk for LRR appeared to increase with each additional involved lymph node and was significantly higher in patients with more than 50% axillary lymph node involvement at the time of mastectomy.
Damast and co-authors conclude that their treatment regimen was effective and tolerable, with excellent locoregional outcomes. In spite of this, distant metastases-free survival remains a significant therapeutic challenge that warrants further study, they say. The researchers add that caution must be used in applying these data to all IBC patients because they excluded patients that had metastatic or recurrent disease before radiotherapy.
The study findings are published in the International Journal of Radiation Oncology Biology Physics
By Laura Dean
22 July 2010