INFLAMMATORY BREAST-CANCER - ENHANCED LOCAL-CONTROL WITH HYPERFRACTIONATED RADIOTHERAPY AND INFUSIONAL VINCRISTINE, IFOSFAMIDE AND EPIRUBICIN

Local control rate for inflammatory breast cancer (IBC) is <50% with s tandard chemotherapy-radiotherapy regimen. Nineteen women (age range 4 0-65, median 50) with IBC (18 patients) or with a primary tumour of >1 0 cm (one patient) received a novel treatment comprising hyperfraction ated radiotherapy (HFRT) sandwiched between two cycles of infusional c hemotherapy using vincristine, ifosfamide and epirubicin (VIE). The pr imary endpoint was local control. VIE was continuously infused for six weeks via a Hickman's line using a Deltec CADD-1 ambulatory pump. Ifo sfamide (3 gm/m(2)) mixed with equi-dose mesna was infused for seven d ays and alternated every week with an infusion of epirubicin (50 mg/m( 2)) mixed with vincristine (1.5 mg/m(2)). HFRT consisted of 1.5 Gy twi ce daily for 34 frct (51 Gy) followed by a boost of 15 Gy in 10 frct. The total treatment time was less than 22 weeks. Median follow-up was 37 months. Local control rate was 58%. Three patients failed to respon d initially and five relapsed in the breast at a median time of 36.8 m onths. Medium overall and disease-free survival was 18 and 25.3 months respectively. Toxicity from VIE was minimal (WHO gd 3 emesis - two pa tients, gd 3 mucositis - one patient, neutropenic sepsis - three patie nts). Radiotherapy caused moist desquamation in 17/19 patients. Twenty -four central lines were complicated by seven line infections, three t hromboses, and one extravasation. Thr local control rare of 58% with V IE+HFRT appears similar to reported chemoradiotherapy regimen, althoug h the treatment time of 22 weeks is much shorter than other regimens w hich take up to 12 months, Toxicity is acceptable. Hickman-related com plications need to be reduced. The study is ongoing.