MANAGEMENT OF LOCALLY ADVANCED-CARCINOMA OF THE BREAST .2. INFLAMMATORY CARCINOMA

Background. Inflammatory carcinoma of the breast has been associated w ith a poor prognosis. Several therapeutic approaches have been under i nvestigation in an effort to improve outcome. Methods. This is a retro spective analysis of 179 patients with histologically confirmed inflam matory carcinoma of the breast: 33 treated with irradiation alone, 35 with combined irradiation and chemotherapy, 25 with irradiation and su rgery, and 86 with a combination of three modalities. Results. The 5-y ear disease free survival (DFS) rates were 40% for patients treated wi th three modalities, 24% for those treated with irradiation and surger y, and 6% for those treated with irradiation alone or in combination w ith chemotherapy without a surgical procedure. The 10-year DFS rates w ere 35%, 24%, and 0%, respectively. Cause specific survival (CSS) curv es closely follow the same trends. A clearly superior locoregional tum or control was observed in patients who underwent a surgical procedure : 79% with three modalities, 76% with irradiation and surgery, and onl y 30% with irradiation alone or in combination with chemotherapy. Dist ant metastasis occurred in 57% of the group treated with triple-modali ty therapy, 60% of those treated with irradiation plus surgery, and 85 % of the patients treated with irradiation alone or in combination wit h chemotherapy. There was no significant correlation between the type of mastectomy or doses of irradiation and locoregional tumor control o r survival. The significant morbidity of the trimodal therapy (10%), a lthough somewhat higher than that of other modalities (3.2%), was acce ptable. Conclusions. The addition of mastectomy to irradiation signifi cantly improved locoregional tumor control, DFS, and CSS; differences were statistically significant. The combination of chemotherapy, surge ry, and irradiation had a significant impact on locoregional tumor con trol and incidence of distant metastases compared with surgery plus ir radiation, and a lesser impact, although still statistically significa nt, on DFS and CSS. Further clinical trials are needed to optimize the management of patients with inflammatory breast cancer.