COMBINED-MODALITY TREATMENT OF INFLAMMATORY BREAST-CARCINOMA - 20 YEARS OF EXPERIENCE AT M.D.-ANDERSON-CANCER-CENTER

Purpose: To review the 20 years of experience at M, D. Anderson Cancer Center with a combined-modality approach against inflammatory breast carcinoma. Patients anti methods: A total of 178 patients with inflamm atory breast carcinoma were treated in the past 20 years at M. D. Ande rson Cancer Center by a combined-modality approach under four differen t protocols. Each protocol included induction chemotherapy, then local therapy (radiotherapy or mastectomy), then adjuvant chemotherapy, and , if mastectomy was performed, adjuvant radiotherapy. Chemotherapy con sisted of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAG) with or without vincristine and prednisone (VP). In protocol D, patients r eceived an alternate adjuvant chemotherapy regimen, methotrexate and v inblastine (MV), if they did not have a complete response (CR) to indu ction chemotherapy. Results: The median follow-up of live patients in group A was 215 months, in group B 186 months, in group C 116 months, and in group D 45 months. An estimated 28% of patients were currently free of disease beyond 15 years. At the time of analysis, 50 patients were alive without any evidence of disease. A further 12 patients died of intercurrent illness, and 15 patients were followed beyond 10 year s without recurrence of disease. Among initial recurrence, 20% of pati ents had local failure, 39% systemic failure, and 9% CNS recurrence. I nitial response to induction chemotherapy was an important prognostic factor. Disease-free survival (DFS) at 15 years was 44% in patients wh o had a CR to induction chemotherapy, 31% in those who had a partial r esponse (PR), and 7% in those who had less than a PR. There was no imp rovement in overall survival (OS) or DFS among patients who underwent alternate chemotherapy (MV) compared with those who did not. Using sur gery and radiotherapy as opposed to radiotherapy alone as local therap y did not have an impact on the DFS or OS rate. Conclusion: These long term follow-up data show that with a combined-modality approach a sign ificant fraction of patients (28%) remained free of disease beyond 15 years. In contrast, single-modality treatments yielded a DFS of less t han 5%. Thus, using combined-modality treatment (chemotherapy, then ma stectomy, then chemotherapy and radiotherapy) is recommended as a stan dard of care for inflammatory breast carcinoma.