Inflammatory breast carcinoma treated by radical radiotherapy

Sixty-two patients with localized clinical inflammatory breast carcinoma were treated with curative, radical radiotherapy doses to the breast and draining lymphatics at Massachusetts General Hospital from January 1960 to December 1977. Fifty patients have died from disease, 7 are alive with disease, and 5 are free of disease at time of reporting, thus indicating the fulminant nature of this rare form of breast cancer. Median survival is approximately 18 months (mean 24 months). A five-year actuarial survival relapse-free survival of 14% and 6%, respectively, are obtained. Local and regional recurrence was noted in 43 of 62 patients (69%). Twelve patients (19%) failed in the locally irradiated area only, 31 patients (50%) failed in both local, regional, and distant sites, and 14 patients (23%) failed with distant metastases only. Due to the complex dosimetry required in the treatment of breast cancer, retrospective analysis was made of actual tumor doses delivered before 1972. The breast was oftentimes calculated to receive 20 to 35% less than the stated dose. This gave the unique opportunity of observing a dose response relationship in local control within the same institution. Doses in excess of 6000 rads tumor dose seem necessary since 14 of the 15 patients with persistent disease had received less than this dose. However, once tumor exceeded 10 cm, increasing dose within clinical therapeutic ranges failed to control disease, although the recurrence-free interval was somewhat prolonged. Since 1976, twice-a-day fractionation has been used in larger tumors, and this appears to have decreased the local recurrence rate to 33% (2/6) patients. Preliminary results of adjuvant multiple drug therapy, e.g., modified Cooper regimen (CMFVP) or the CMF regime appear encouraging.