Chemotherapy and concomitant irradiation in inflammatory breast cancer

The purpose of this study was to evaluate the efficacy of concurrent chemot herapy and irradiation in inflammatory breast cancer (IBC). Between January , 1990 and December 1998, forty-eight non-metastatic patients with clinical or occult IBC were treated with chemotherapy and irradiation. The inductio n chemotherapy consisted of epirubicin, cyclophosphamide and vindesin, in a ssociation with split-course bi-fractionated irradiation to a total dose of 65 Gy with concomitant cisplatin and fluorouracil. Maintenance chemotherap y consisted of high-dose methotrexate and 6 cycles of epirubicin, cyclophos phamide and fluorouracil. Hormonal treatment was given routinely but mastec tomies were not routinely performed. A high rate of locoregional control wa s obtained in 47 evaluable patients of whom 93.6% achieved a complete clini cal response. Three patients had locoregional relapses, always with concomi tant metastatic dissemination. In 47 patients, 21 developed metastatic diss emination with a median delay of 23 months. Median disease-free survival (D FS) was 45 months. Median overall survival (OS) has not yet been reached af ter a median follow-up of 44.5 months. The 3-year DFS rate was 53% and the 3-year OS rate was 71%. Toxicity was mainly hematological. During the induc tion therapy, grade 3 or 4 neutropenia occurred in 54% of patients, grade 3 or 4 thrombocytopenia in 23% and grade 3 or 4 anemia in 8%. The administra tion of induction chemotherapy and concomitant irradiation is feasible in p atients with IBC. The hematological toxicity of this treatment approach is significant but nevertheless, the treatment achieves a high degree of locor egional control and improved survival.