Management of inflammatory carcinoma of breast with combined modality approach - an update

Thirty-two patients with inflammatory breast cancer were treated with a combined modality approach consisting of combination chemotherapy with fluorouracil, doxorubicin hydrochloride, and cyclophosphamide, followed by radiation therapy. The disease-free interval and survival of this group were compared with 32 patients with inflammatory breast cancer treated with irradiation without systemic therapy at our institution in the past. In the actuarial median follow-up of 62 months (range 42+ to 76+ months) of study, 11 patients in combined modality group and three patients in the irradiation group were free of disease. Overall median disease-free interval was 22.8 months for the combined modality group and nine months for the irradiation group, and 30.1 months and 18 months, respectively. The median disease-free interval of patients less than 50 years of age was 19 months for the combined modality group and nine months for the irradiation group; median survival was 24 months for both subgroups. Forty percent of the patients under 50 years of age in the combined modality group and 7% in the irradiation group had recurrence of central nervous system disease. Of the patients greater than of equal to 50 years of age, the median disease-free interval was 32.1 months for the combined modality group and nine months for irradiation group; median survival was 42 months and 18 months, respectively. The combined modality approach has resulted in improved disease-free interval of patients less than 50 years of age, but survival of this subgroup was not significantly improved possibly because of the high incidence of central nervous system disease recurrence. This treatment was effective in prolonging the disease-free interval and survival of patients greater than or equal to 50 years of age, with an estimated 45% of the patients surviving free of disease beyond 42 months.