Inflammatory breast cancer: integration of irradiation, surgery, and chemotherapy

Between January 1983 and April 1987, 36 consecutive patients with nonmetastatic clinical (30 patients) or occult (6 patients) inflammatory breast cancer were treated with irradiation, mastectomy, and chemotherapy. In 29 patients, treatment consisted of preoperative once daily (16 patients) or twice daily (13 patients) irradiation with concurrent chemotherapy. In 27 (93%) of these 29 patients, this treatment was followed by mastectomy and additional chemotherapy. In 25 (86%) of these patients, major clinical response was attained, but an examination of the pathology of the operative specimen revealed complete tumor absence in only two patients (7%). The remaining seven patients underwent immediate mastectomy followed by once daily irradiation and chemotherapy. With a median follow-up of 30.4 months in all patients (59.2 months in surviving patients), the 5-year probability of relapse-free survival was 24% and of overall survival, 34%. Overall, the probability at 5 years of initial isolated local-regional tumor recurrence was 19%; in patients treated with once daily irradiation, the 5-year probability was 28%, whereas the probability was 8% with twice daily (accelerated) fractionated irradiation. Chemotherapy dose intensity did not appear to be adversely affected by the use of irradiation. The treatment approach described herein provides results comparable with those in other contemporary American series.