Inflammatory breast cancer: current concepts in local management

Inflammatory breast cancer (IBC) is a very aggressive form of breast carcinoma marked by rapid disease progression and early distant dissemination. Despite this fact, nearly 70% of patients diagnosed with (IBC) will have localized disease at presentation. As survival for patients with IBC has improved with the addition and routine use of doxorubicin-based chemotherapy, local management has emerged as a critical component of the curative management of these patients. Over the last two decades, local control rates for patients with IBC have dramatically improved. Utilization of a combined-modality approach employing neoadjuvant chemotherapy followed by mastectomy and adjuvant chemotherapy with accelerated hyperfractionated radiation to 66 Gy has transformed what was once a disease with local control rates less than 50% to one with local control rates on the order of 70%-80%. In patients whose disease responds to chemotherapy, the 5-year local control rates are even higher. These improvements in local control have translated into improvements in survival. In this paper, we review many of the exciting advances in locoregional management of IBC. We analyze the relevant literature pertaining to those local treatment options, review treatment techniques, and provide evidence-based treatment recommendations fro practicing oncologists.