Exclusive Alternating Chemotherapy and Radiotherapy in Nonmetastatic Inflammatory Breast Cancer: 20 Years of Follow-Up

• Published in: International journal of radiation oncology, biology, physics Vol. 82; no. 2; pp. 690 - 695
• Main Authors: Bourgier, Céline, M.D., Ph.D, Pessoa, Eduardo Lima, M.D, Dunant, Ariane, Ph.D, Heymann, Steve, M.D, Spielmann, Marc, M.D, Uzan, Catherine, M.D., Ph.D, Mathieu, Marie-Christine, M.D, Arriagada, Rodrigo, M.D, Marsiglia, Hugo, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2012; Elsevier
• Subjects: Adult; Aged; Alternating chemo-radiotherapy; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Brachial Plexus Neuropathies - epidemiology; Brachial Plexus Neuropathies - pathology; Carcinoma, Ductal, Breast - drug therapy; Carcinoma, Ductal, Breast - mortality; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - radiotherapy; Carcinoma, Lobular - drug therapy; Carcinoma, Lobular - mortality; Carcinoma, Lobular - pathology; Carcinoma, Lobular - radiotherapy; CHEMOTHERAPY; CLINICAL TRIALS; Combined Modality Therapy - methods; Cyclophosphamide - administration & dosage; Dose Fractionation; Doxorubicin - administration & dosage; Drug Administration Schedule; ENDOXAN; Epirubicin - administration & dosage; Female; FIBROSIS; Fluorouracil - administration & dosage; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Heart - radiation effects; Hematology, Oncology and Palliative Medicine; HORMONES; Humans; INFLAMMATION; Inflammatory breast cancer; Inflammatory Breast Neoplasms - drug therapy; Inflammatory Breast Neoplasms - mortality; Inflammatory Breast Neoplasms - pathology; Inflammatory Breast Neoplasms - radiotherapy; IRRADIATION; Mammary gland diseases; MAMMARY GLANDS; Medical sciences; Medicin och hälsovetenskap; METASTASES; METHOTREXATE; Methotrexate - administration & dosage; Middle Aged; Neoplasm Recurrence, Local; NEOPLASMS; PATIENTS; PNEUMONITIS; Radiation Injuries - pathology; Radiation Pneumonitis - epidemiology; Radiation Pneumonitis - pathology; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; SURGERY; Survival Rate; TAMOXIFEN; Tamoxifen - administration & dosage; Time Factors; TOXICITY; Tumors; URACILS; Vincristine - administration & dosage; WOMEN; Inflammatory breast cancer; Alternating chemo-radiotherapy; Breast disease; Breast cancer; Inflammation; Malignant tumor; Radiotherapy; Mammary gland diseases; Chemotherapy; Treatment; Cancerology; Follow up study; Cancer
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.11.040

Background Locoregional treatment of inflammatory breast cancer (IBC) is crucial because local relapses may be highly symptomatic and are commonly associated with distant metastasis. With a median follow-up of 20 years, we report here the long-term results of a monocentric clinical trial combining primary chemotherapy (CT) with a schedule of anthracycline-based CT and an alternating split-course of radiotherapy (RT∗CT) without mastectomy. Methods and Materials From September 1983 to December 1989, 124 women with nonmetastatic IBC (T4d M0) were treated with three cycles of primary AVCMF chemotherapy (anthracycline, vincristine, cyclophosphamide, methotrexate, and 5-fluorouracil) and then an alternating RT∗CT schedule followed by three cycles of FAC. Hormonal therapy was systematically administered: ovarian irradiation (12 Gy in four fractions) or tamoxifen 20 mg daily. Results Local control was achieved in 82% of patients. The 10- and 20-year local relapse rates were 26% and 33%, respectively, but only 10% of locally controlled cases were not associated with concurrent distant metastasis. The 10- and 20-year overall survival rates were 39% and 19%, respectively. Severe fibrosis occurred in 54% of patients, grade 3 brachial plexus neuropathy in 4%, grade 2 pneumonitis in 9%. Grade 1, 2 and 3 cardiac toxicity was observed in 3.8%, 3.8% and 1.2% of cases respectively. Conclusions This combined regimen allowed good long-term local control without surgery. Survival rates were similar to those obtained with conventional regimens (primary chemotherapy, total mastectomy, and adjuvant radiotherapy). Since IBC continues to be an entity with a dismal prognosis, this approach, safely combining preoperative or postoperative radiation therapy and systemic treatments, should be reassessed when suitable targeted agents are available.