Multimodality therapy in inflammatory breast cancer: Is there a place for surgery?

Background: In many centres surgery is used as part of a combined modality approach to the treatment of inflammatory breast cancer (IBC). Nevertheless , its value is controversial given the high risk of metastatic relapse and poor overall prognosis. We have reviewed patients with true IBC prospective ly treated at the Royal Marsden Hospital in chemotherapy trials to assess f urther the role of surgery as part of combined modality treatment. Patients and methods: Fifty-four patients who had responsive or stable dise ase to primary chemotherapy went on to have either radiotherapy alone (n = 35) or surgery plus radiotherapy (n = 19); the decision on surgery was base d partly on clinician preference and partly on clinical response. Results: The 35 patients undergoing radiotherapy alone had a median progres sion-free survival (PFS) of 16 months and median overall survival (OS) of 3 5 months. Twenty-four patients (69%) have relapsed with a total of twelve ( 34%) relapsing locally. In comparison, the 19 patients receiving both surge ry and radiotherapy had a PFS of 20 months, and a median OS of 35 months. F ifteen patients (79%) have relapsed, eight (42%) of these locally. None of these differences were statistically significant. Conclusions: These results do not suggest a clinical advantage for surgery in addition to chemotherapy and radiotherapy for patients with IBC. They su pport the need for a prospective randomised trial to address this question.