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Evolving Treatment Strategies for Inflammatory Breast Cancer: A Population-Based Survival Analysis

From the Breast Cancer Outcomes Unit, Radiation, and Systemic Therapy Programs of the BC Cancer Agency, University of British Columbia, and University of Victoria, Victoria, British Columbia, Canada

Address reprint requests to I.A. Olivotto, MD, Breast Cancer Outcomes Unit, BC Cancer Agency—Vancouver Island Centre, 2410 Lee Avenue, Victoria, BC, Canada V8R 6V5; e-mail: iolivott{at}bccancer.bc.ca

PURPOSE: To determine if mastectomy (Mx) use, chemotherapy (CT) intensity, or treatment sequence of CT, radiation therapy (RT), and Mx have improved outcome for inflammatory breast cancer (IBC).

PATIENTS AND METHODS: A retrospective analysis of 485 patients with IBC diagnosed in British Columbia between 1980 and 2000 analyzed locoregional relapse-free survival (LRFS) and breast cancer–specific survival (BCSS) by treatment intent and treatment received. Curative intent was defined as delivery of more than four cycles of anthracycline-based CT plus locoregional RT in patients without distant metastases.

RESULTS: Median follow-up among survivors was 6.5 years. Median BCSS was 1.0 and 3.2 years for patients with distant metastases at diagnosis or those who were curatively treated, respectively. Among patients treated curatively (n = 308), there were no significant differences in LRFS or BCSS with timing of Mx before or after CT/RT, time between diagnosis and RT, or the sequence of RT and CT. Patients receiving more intensive CT had improved 10-year BCSS compared with standard CT (43.7% v 26.3%; P = .04). Ten-year LRFS for patients having Mx after CT, Mx before CT, and without Mx was 62.8%, 58.6%, and 34.4%, respectively (P = .0001); the corresponding 10-year BCSS was 36.9%, 19.9%, and 22.5%, respectively (P = .005). On multivariate analysis, Mx was associated with improved LRFS (P = .04). Independent prognostic factors for BCSS were menopausal status (P = .02), estrogen receptor status (P = .02), and CT type (P = .05).

CONCLUSION: This retrospective analysis suggested that mastectomy, in conjunction with CT and RT, seemed to enhance locoregional control, whereas modern CT regimens seemed to improve BCSS.

Supported by a grant from the Canadian Breast Cancer Foundation, British Columbia and Yukon Chapters.

Presented in part at the Canadian Association of Radiation Oncologists Annual Meeting, Halifax, Nova Scotia, September 9–12, 2004, and San Antonio Breast Cancer Symposium, San Antonio, TX, December 8–11, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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