Beyond palliative mastectomy in inflammatory breast cancer - A reassessment of margin status

Background: Inflammatory breast cancer is a locally advanced tumor with an aggressive local and systemic course. Treatment of this disease has been ev olving over the last several decades. The aim of this study was to assess w hether current therapies, both surgical and chemotherapeutic, are providing better local control (LC) and overall survival (OS). We also attempted to identify clinical and pathologic factors that may be associated with improv ed OS, disease-free survival (DFS), and LC. Methods: A 25-year retrospective review performed at the City of Hope Natio nal Medical Center identified 90 patients with the diagnosis of inflammator y breast cancer. Results: Of the 90 patients identified with inflammatory breast cancer, 33 received neoadjuvant therapy (NEO) consisting of chemotherapy followed by s urgery with radiation (n = 26) and without radiation (n = 7). Fifty-seven p atients received other therapies (nonNEO). Treatments received by the nonNE O group consisted of chemotherapy, radiation, mastectomy, adrenalectomy, an d oophorectomy, alone or in combination. The median follow-up was 28.9 mont hs for the NEO group and 17.6 months for the nonNEO group. Borderline signi ficant differences in the OS distributions between the two groups were foun d (P = .10), with 3- and 5-year OS for the NEO group of 40.0% and 29.9% and for the nonNEO group of 24.7% and 16.5%, respectively. DFS and LC were com parable in the two groups. Lower stage was associated with an improved OS ( P < .05). The 5-year OS for stage IIIB was 30.9%, compared to 7.8% for stag e TV. In those patients with stage III disease who were treated with mastec tomy and rendered free of disease, margin status was identified by univaria te analysis to be a prognostic indicator for OS (P < .05). The 3-year OS, D FS, and LC for patients with negative margins were 47.4%, 37.5%, and 60.3%, respectively, compared to 0%, 16.7%, and 31.3% in patients with positive m argins. Conclusions: This study suggests that in patients with inflammatory breast cancer and nonmetastatic disease, an aggressive surgical approach may be ju stified with the goal of a negative surgical margin. Achievement of this lo cal control is associated with a better overall outcome for this subset of patients. The ability to obtain negative margins may further identify a gro up of patients with a less aggressive tumor biology that may be more respon sive to other modalities of therapy.