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Tay KLY, Cowan G, Chatterji S, Conti G, Speirs V. Exploring the One Health Paradigm in Male Breast Cancer. J Mammary Gland Biol Neoplasia 2024; 29:8. [PMID: 38573417 PMCID: PMC10995048 DOI: 10.1007/s10911-024-09560-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
How cancer patterns in humans compare to those of other species remains largely unknown and there is an even bigger knowledge gap for rare cancers like male breast cancer. One Health is a convergence of human and animal healthcare that encourages cross-pollination of medical research uniting human and veterinary medicine. Recognising that breast cancer occurs spontaneously in other male species (e.g. primates, canines, felines), and knowing that no laboratory models exist for male breast cancer, which limits our ability to perform functional studies, we explored the feasibility of applying One Health to breast cancer in men by conducting a narrative review of the topic. Spontaneous development of breast cancer was reported in captive male primates and in companion canines and felines. Some parallels in tumour biology of human male breast cancer with canines and primates were found. The age distribution, pattern of biomarker expression and metastasis were similar, with mammary tumours typically detected after two-thirds of average lifespan. However, instances of triple negative and inflammatory breast cancer, which are rarely observed in human male breast cancer, were found in canines and histological classification was inconsistent between species. These disparities need redressing to enable full exploration of the One Health paradigm in rare cancers.
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Affiliation(s)
- Kirsty Luo-Yng Tay
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - George Cowan
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Subarnarekha Chatterji
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
- Aberdeen Cancer Centre, Aberdeen, UK
| | - Giulia Conti
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Valerie Speirs
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
- Aberdeen Cancer Centre, Aberdeen, UK.
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Sahraoui G, Rahoui N, Driss M, Mrad K. Inflammatory breast cancer: An overview about the histo-pathological aspect and diagnosis. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2024; 384:47-61. [PMID: 38637099 DOI: 10.1016/bs.ircmb.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Inflammatory Breast Cancer (IBC) is a rare and aggressive form of locally advanced breast cancer, classified as stage T4d according to the tumor-node-metastasis staging criteria. This subtype of breast cancer is known for its rapid progression and significantly lower survival rates compared to other forms of breast cancer. Despite its distinctive clinical features outlined by the World Health Organization, the histopathological characteristics of IBC remain not fully elucidated, presenting challenges in its diagnosis and treatment. Histologically, IBC tumors often exhibit a ductal phenotype, characterized by emboli composed of pleomorphic cells with a high nuclear grade. These emboli are predominantly found in the papillary and reticular dermis of the skin overlaying the breast, suggesting a primary involvement of the lymphatic vessels. The tumor microenvironment in IBC is a complex network involving various cells such as macrophages, monocytes, and predominantly T CD8+ lymphocytes, and elements including blood vessels and extracellular matrix molecules, which play a pivotal role in the aggressive nature of IBC. A significant aspect of IBC is the frequent loss of expression of hormone receptors like estrogen and progesterone receptors, a phenomenon that is still under active investigation. Moreover, the overexpression of ERBB2/HER2 and TP53 in IBC cases is a topic of ongoing debate, with studies indicating a higher prevalence in IBC compared to non-inflammatory breast cancer. This overview seeks to provide a comprehensive understanding of the histopathological features and diagnostic approaches to IBC, emphasizing the critical areas that require further research.
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Affiliation(s)
- Ghada Sahraoui
- Department of histopathology, Salah Azaiez Cancer Institute, Tunisia.
| | - Nabil Rahoui
- Department of Pathology and Laboratory Medicine, University of North Carolina Chapel Hill, United States
| | - Maha Driss
- Department of histopathology, Salah Azaiez Cancer Institute, Tunisia
| | - Karima Mrad
- Department of histopathology, Salah Azaiez Cancer Institute, Tunisia
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Scardina L, Masetti R, Franceschini G. Conserving surgery in inflammatory breast cancer after neoadjuvant chemotherapy in patients with clinical complete response: the ConSIBreC randomized controlled trial. Front Oncol 2024; 14:1372633. [PMID: 38463227 PMCID: PMC10921562 DOI: 10.3389/fonc.2024.1372633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
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Franceschini G, Masetti R. Inflammatory breast cancer: is conservative surgery possible? Minerva Surg 2024; 79:1-3. [PMID: 37817477 DOI: 10.23736/s2724-5691.23.09980-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Affiliation(s)
- Gianluca Franceschini
- Breast Unit, Department of Woman and Child's Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy -
| | - Riccardo Masetti
- Breast Unit, Department of Woman and Child's Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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Kuhar CG, Borštnar S, Gazić B, Matos E. Complete response in the axilla and the non-triple negative subtype are favourable prognostic factors for survival outcomes in inflammatory breast cancer. Breast 2023:S0960-9776(23)00011-5. [PMID: 36740512 DOI: 10.1016/j.breast.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
AIM To assess real-world outcomes and prognostic factors of non-metastatic inflammatory breast cancer according to immunohistochemistry (IHC)-based subtype and treatment regimen. METHODS An institutional retrospective analysis of patients treated with neoadjuvant systemic treatment (NAST) for stage III inflammatory breast cancer diagnosed between 2001 and 2018 was performed. The survival outcomes in relation to patient characteristics, tumour characteristics, treatment modality and response to NAST were analyzed. RESULTS 225 patients fulfilled the inclusion criteria, 90% of patients were node-positive. IHC-based subtypes: 39.1% were HR+/HER2-, 19.1% HR+/HER2+, 23.1% HR-/HER2+ and 18.7% HR-/HER2-. Treatment was multimodal: NAST (100%), surgery (94.2%) and radiotherapy (94.2%). 53.3% of patients received adjuvant endocrine therapy, 34.3% (neo)adjuvant trastuzumab. Tri-modality therapy was applied in 89.3% of patients. Following NAST, a pathologic complete remission (pCR) in the breast was found in 16.9%, in the axilla in 29.7% and in both the breast and axilla in 10.3% of patients. The axillary pCR rate was significantly higher in HR- subtypes. Median overall survival (OS) was 8.9, 7.2, 5.8 and 2.3 years (p < 0.001) for HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- subtype, respectively. On multivariate analysis, IHC-based subtype, age and axillary pCR were found as independent prognostic factors for RFS and OS. pCR rate and median OS improved over time, 5.8% vs 14.7% and 4.7 vs 10.0 years (2001-2009 vs. 2010-2018), respectively. CONCLUSIONS Axillary pCR and the non-triple-negative IHC-based subtype are favourable prognostic factors for RFS and OS in inflammatory breast cancer. Introduction of taxanes and antiHER2 drugs contributed to improved pCR rate and OS.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
| | - Simona Borštnar
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
| | - Barbara Gazić
- Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia; Institute of Oncology Ljubljana, Department of Pathology, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Erika Matos
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia.
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Nakhlis F. Inflammatory Breast Cancer: Is There a Role for Deescalation of Surgery? Ann Surg Oncol 2022; 29:6106-6113. [PMID: 35840847 DOI: 10.1245/s10434-022-12138-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
Inflammatory breast cancer (IBC) is a rare and aggressive presentation of breast cancer, characterized by higher propensity for locoregional recurrence and distant metastasis compared with non-IBC. Because of extensive parenchymal and overlying dermal lymphatic involvement by carcinoma, IBC is unresectable at diagnosis. Trimodality therapy (neoadjuvant chemotherapy followed by modified radical mastectomy and adjuvant comprehensive chest wall and regional nodal radiotherapy) has been a well-accepted treatment algorithm for IBC. Over the last few decades, several innovations in systemic therapy have resulted in rising rates of pathologic complete response (pCR) in both the affected breast and the axilla. The latter may present an opportunity for deescalation of lymph node surgery in patients with IBC, as those with an axillary pCR may be able to avoid an axillary dissection. To this end, feasibility data are necessary to address this question. There are very limited data on the safety of breast conservation of IBC; therefore, mastectomy remains the standard of care for this disease. There are also no data addressing the safety of immediate reconstruction in patients with IBC. Considering that some degree of deliberate skin-sparing to facilitate immediate breast reconstruction would be expected, given the extensive skin involvement by disease at diagnosis, the safest oncologic strategy to breast reconstruction in IBC would be the delayed approach.
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Affiliation(s)
- Faina Nakhlis
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Chakrabarthi S, Panwar S, Singh T, Lad S, Srikala J, Khandelwal N, Misra S, Thulkar S. Best Practice Guidelines for Breast Imaging: Breast Imaging Society, India: Part—2. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1744392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractBreast imaging is one of the prerequisites for providing high-quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease or the absence of it in women and men who present to health professionals for treatment. Patients with breast disease present to doctors of different subspecialties as well as general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different health care setups of our country, urban and rural, and government and private, for breast diseases to be diagnosed and treated optimally. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. These guidelines aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The guidelines encompass all aspects of breast imaging including mammography, breast ultrasound, breast magnetic resonance imaging, as well as breast interventions. Algorithms for the investigation of specific common breast symptoms and signs have been provided in this document. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases so that breast cancer is not missed. Breast screening is an integral part of breast imaging, and guidelines for the same have been incorporated in this document. In the absence of a population-based screening program in India, the guidelines to be followed for those women who wish to be screened by mammography have been provided. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India.
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Affiliation(s)
- Suma Chakrabarthi
- Department of Radiology and Imaging, Peerless Hospitex Hospital and Research Center Limited, Kolkata, West Bengal, India
| | - Shikha Panwar
- Department of Radiology, Mahajan Imaging, Delhi, India
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shilpa Lad
- Department of Radiology, NM Medical, Mumbai, Maharashtra, India
| | - Jwala Srikala
- Department of Radiology and Imaging, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Niranjan Khandelwal
- Former Head, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjay Thulkar
- Department of Radiology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India
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Jagsi R, Mason G, Overmoyer BA, Woodward WA, Badve S, Schneider RJ, Lang JE, Alpaugh M, Williams KP, Vaught D, Smith A, Smith K, Miller KD. Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research. Breast Cancer Res Treat 2022; 192:235-243. [PMID: 34973083 PMCID: PMC8926970 DOI: 10.1007/s10549-021-06434-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022]
Abstract
Purpose Inflammatory breast cancer is a deadly and aggressive type of breast cancer. A key challenge relates to the need for a more detailed, formal, objective definition of IBC, the lack of which compromises clinical care, hampers the conduct of clinical trials, and hinders the search for IBC-specific biomarkers and treatments because of the heterogeneity of patients considered to have IBC. Methods Susan G. Komen, the Inflammatory Breast Cancer Research Foundation, and the Milburn Foundation convened patient advocates, clinicians, and researchers to review the state of IBC and to propose initiatives to advance the field. After literature review of the defining clinical, pathologic, and imaging characteristics of IBC, the experts developed a novel quantitative scoring system for diagnosis. Results The experts identified through consensus several “defining characteristics” of IBC, including factors related to timing of onset and specific symptoms. These reflect common pathophysiologic changes, sometimes detectable on biopsy in the form of dermal lymphovascular tumor emboli and often reflected in imaging findings. Based on the importance and extent of these characteristics, the experts developed a scoring scale that yields a continuous score from 0 to 48 and proposed cut-points for categorization that can be tested in subsequent validation studies. Conclusion To move beyond subjective ‘clinical diagnosis’ of IBC, we propose a quantitative scoring system to define IBC, based on clinical, pathologic, and imaging features. This system is intended to predict outcome and biology, guide treatment decisions and inclusion in clinical trials, and increase diagnostic accuracy to aid basic research; future validation studies are necessary to evaluate its performance. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06434-x.
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Affiliation(s)
- R Jagsi
- University of Michigan, Ann Arbor, MI, USA
| | - G Mason
- Inflammatory Breast Cancer Research Foundation, West Lafayette, IN, USA
- Susan G. Komen Advocates in Science, Dallas, TX, USA
| | | | - W A Woodward
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Badve
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, 535 Barnhill Drive, RT 473, Indianapolis, IN, 46202, USA
| | - R J Schneider
- New York University School of Medicine, New York, NY, USA
| | - J E Lang
- Cleveland Clinic, Cleveland, OH, USA
| | - M Alpaugh
- Rowan University, Glassboro, NJ, USA
| | - K P Williams
- North Carolina Central University, Durham, NC, USA
| | | | - A Smith
- Susan G. Komen, Dallas, TX, USA
| | - K Smith
- Susan G. Komen, Dallas, TX, USA
| | - K D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, 535 Barnhill Drive, RT 473, Indianapolis, IN, 46202, USA.
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Lehrberg A, Sebai M, Finn D, Lee D, Karabon P, Kiran S, Dekhne N. Trends, survival outcomes, and predictors of nonadherence to mastectomy guidelines for nonmetastatic inflammatory breast cancer. Breast J 2021; 27:753-760. [PMID: 34431161 DOI: 10.1111/tbj.14283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Current National Comprehensive Cancer Network guidelines recommend modified radical mastectomy (MRM) as the surgical treatment of choice for nonmetastatic inflammatory breast cancer (IBC). Limited studies have looked into the outcomes of breast conserving surgery (BCS) vs. MRM for IBC. METHODS National Cancer Database (NCDB) data from 2004 to 2014 were retrospectively analyzed. Patients' demographics, tumor characteristics, and overall survival (OS) trends were compared for BCS and MRM cases of nonmetastatic IBC. Univariate and multivariate analyses were performed. RESULTS A total of 413 (3.89%) BCS and 10,197 (96.11%) MRM cases were identified. Median follow-up was 58.45 months. Compared to MRM, BCS patients were more likely to be older, be African American, have Medicare/Medicaid or be uninsured, live in lower education ZIP codes, and live in a metropolitan area (all p < 0.05). BCS rates significantly decreased from 5.84% in 2004 to 3.19% in 2014 (p < 0.001). BCS patients also were more likely to have less than 50% of the breast involved (51.57% vs. 43.88%; p = 0.0081) and were less likely to receive trimodal therapy (50.85% vs. 74.62%; p = <0.0001). The OS was significantly higher in the mastectomy group over 9 years at 62.02% vs. 54.47% in the BCS group. Additionally, in the adjusted multivariate model, BCS cases were associated with 23% higher hazards of overall mortality (p = 0.0091). CONCLUSION BCS was performed in a limited number of cases, which decreased over the study period. The analysis identified both demographic predictors of receiving BCS and significantly lower OS for IBC patients undergoing a BCS.
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Affiliation(s)
- Anna Lehrberg
- Breast Cancer Center, Beaumont Health, Oakland University WB School of Medicine, Royal Oak, Michigan, USA
| | - Mohamad Sebai
- Breast Cancer Center, Beaumont Health, Oakland University WB School of Medicine, Royal Oak, Michigan, USA
| | - Daniel Finn
- Breast Cancer Center, Beaumont Health, Oakland University WB School of Medicine, Royal Oak, Michigan, USA
| | - David Lee
- Breast Cancer Center, Beaumont Health, Oakland University WB School of Medicine, Royal Oak, Michigan, USA
| | - Patrick Karabon
- Breast Cancer Center, Beaumont Health, Oakland University WB School of Medicine, Royal Oak, Michigan, USA
| | - Sayee Kiran
- Breast Cancer Center, Beaumont Health, Oakland University WB School of Medicine, Royal Oak, Michigan, USA
| | - Nayana Dekhne
- Breast Cancer Center, Beaumont Health, Oakland University WB School of Medicine, Royal Oak, Michigan, USA
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Balema W, Liu D, Shen Y, El-Zein R, Debeb BG, Kai M, Overmoyer B, Miller KD, Le-Petross HT, Ueno NT, Woodward WA. Inflammatory breast cancer appearance at presentation is associated with overall survival. Cancer Med 2021; 10:6261-6272. [PMID: 34327874 PMCID: PMC8446552 DOI: 10.1002/cam4.4170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/07/2021] [Accepted: 07/03/2021] [Indexed: 11/06/2022] Open
Abstract
Background Inflammatory breast cancer (IBC) is a clinical diagnosis. Here, we examined the association of a “classic” triad of clinical signs, swollen involved breast, nipple change, and diffuse skin change, with overall survival (OS). Method Breast medical photographs from patients enrolled on a prospective IBC registry were scored by two independent reviewers as classic (triad above), not classic, and difficult to assign. Chi‐squared test, Fisher's exact test, and Wilcoxon rank‐sum test were used to assess differences between patient groups. Kaplan–Meier estimates and the log‐rank test and Cox proportional hazard regression were used to assess the OS. Results We analyzed 245 IBC patients with median age 54 (range 26–81), M0 versus M1 status (157 and 88 patients, respectively). The classic triad was significantly associated with smoking, post‐menopausal status, and metastatic disease at presentation (p = 0.002, 0.013, and 0.035, respectively). Ten‐year actuarial OS for not classic and difficult to assign were not significantly different and were grouped for further analyses. Ten‐year OS was 29.7% among patients with the classic sign triad versus 57.2% for non‐classic (p < 0.0001). The multivariate Cox regression model adjusting for clinical staging (p < 0.0001) and TNBC status (<0.0001) demonstrated classic presentation score significantly associated with poorer OS time (HR 2.6, 95% CI 1.7–3.9, p < 0.0001). Conclusions A triad of classic IBC signs independently predicted OS in patients diagnosed with IBC. Further work is warranted to understand the biology related to clinical signs and further extend the understanding of physical examination findings in IBC.
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Affiliation(s)
- Wintana Balema
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Radiation Oncology, Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randa El-Zein
- Department of Radiology, Houston Methodist Cancer Center, Houston, TX, USA
| | - Bisrat G Debeb
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Megumi Kai
- Department of Radiation Oncology, Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kathy D Miller
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Huong T Le-Petross
- Department of Radiation Oncology, Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naoto T Ueno
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy A Woodward
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Radiation Oncology, Morgan Welch IBC Clinic and Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Baker JL, Hegde J, Thompson CK, Lee MK, DiNome ML. Locoregional Management of Inflammatory Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00389-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractPurpose of ReviewInflammatory breast cancer (IBC) is a biologically aggressive subtype with a high risk for rapid local progression and early distant metastasis. We review the updated data for optimal locoregional management of IBC, including areas of active controversy.Recent FindingsAdvancements in tri-modality therapies have improved survival among IBC patients in recent years; however, the risk of locoregional and distant recurrence remains high, particularly in triple-negative IBC. Data to support de-escalation of surgery or radiotherapy is limited, and the recommended treatment approach for non-metastatic IBC remains preoperative systemic therapy (PST), modified radical mastectomy (MRM), and adjuvant radiotherapy in all patients. For patients with de novo metastatic disease, locoregional intervention may be appropriate.SummaryOptimal locoregional management of IBC remains PST followed by MRM and adjuvant radiotherapy. With increasingly effective systemic therapies, research to identify a subset of patients who may benefit from de-escalation of locoregional therapies is warranted.
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Inaguma G, Shimada A, Tsunoda J, Matsuzaki T, Nishi T, Seki H, Matsumoto H. Inflammatory breast cancer associated with amyopathic dermatomyositis: a case report. Surg Case Rep 2020; 6:284. [PMID: 33175305 PMCID: PMC7658279 DOI: 10.1186/s40792-020-01066-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/04/2020] [Indexed: 12/30/2022] Open
Abstract
Background Dermatomyositis is associated with malignant tumors including breast cancer, and inflammatory breast cancer is considered to have a poorer prognosis than most breast cancers. Case presentation A 74-year-old Asian woman, developed erythema on her face, back, and the back of her hands, 3 weeks before attending our department. At the same time, she had noticed a right breast mass and redness of the skin of the breast. The clinical findings and vacuum aspiration biopsy diagnosed inflammatory breast cancer and neoadjuvant chemotherapy was performed. The mass and enlarged axillary lymph nodes had shrunk, therefore a total mastectomy was performed. The sentinel lymph node biopsy was negative. She was discharged 7 days after surgery without any complications. She has received a postoperative aromatase inhibitor and is alive without recurrence. The dermatomyositis also began to improve with the start of her chemotherapy and has not recurred since the surgery. Conclusions Neoadjuvant chemotherapy was performed for inflammatory breast cancer with dermatomyositis, and tumor shrinkage was confirmed. A total mastectomy without axillary lymph node dissection was performed. Dermatomyositis and breast cancer have not recurred. Dermatomyositis may have been a paraneoplastic syndrome due to breast cancer.
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Affiliation(s)
- Gaku Inaguma
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan.
| | - Akihiko Shimada
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Junya Tsunoda
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Tomohiko Matsuzaki
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Tomohiko Nishi
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Hiroaki Seki
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Hidetoshi Matsumoto
- Department of Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
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Abstract
PURPOSE OF REVIEW Inflammatory breast cancer (IBC) is an uncommon but highly aggressive subtype of breast cancer that contributes significantly to breast cancer-related mortality. In this review, we provide an overview of the clinical and molecular characteristics of IBC, and highlight some areas of need for ongoing research. RECENT FINDINGS The disease is characterized by florid tumor emboli that obstruct dermal lymphatics, leading to swelling and inflammation of the affected breast. Recent studies have focused on tumor cell intrinsic features, such as signaling through pathways involved in growth and stem-like behavior, as well as extrinsic features, such as the immune system, that can be leveraged to develop new potential therapies. Key efforts have led to an increase in awareness of the disease as well as new insights into IBC pathogenesis. However, there is a strong need for new therapies designed specifically for IBC, and many unanswered questions remain.
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Affiliation(s)
- Jennifer M Rosenbluth
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Beth A Overmoyer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
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14
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Bottero M, Cancelli A, Alì E, Ponti E, Lancia A, Santoni R, Ingrosso G. Post-operative radiotherapy in the management of metastatic inflammatory breast cancer. JOURNAL OF ONCOLOGICAL SCIENCES 2019. [DOI: 10.1016/j.jons.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Brzezinska M, Dixon JM. Inflammatory breast cancer: no longer an absolute contraindication for breast conservation surgery following good response to neoadjuvant therapy. Gland Surg 2018; 7:520-524. [PMID: 30687625 DOI: 10.21037/gs.2018.08.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Inflammatory breast cancer (IBC) is a rare form of breast cancer characterised by an erythematous swollen breast with extensive oedema and has in the past been associated with a very poor prognosis. After diagnosis by core biopsy of the cancer and any involved nodes patients in the Edinburgh Breast Unit (EBU) are primarily managed with neoadjuvant systemic therapy-chemotherapy or endocrine therapy. If the cancer is localised to one or a few well defined lesions then each of these lesions together with the lowest involved node are clipped. Response during neoadjuvant treatment is monitored clinically and by ultrasound plus mammography +/- magnetic resonance imaging (MRI). Following completion of neoadjuvant therapy, imaging is reviewed at a multidisciplinary meeting and patients with a localised single or multiple areas of cancer where all signs of erythema and oedema have settled are considered as to their suitability for breast conserving surgery and whole breast radiotherapy [breast conserving treatment (BCT)]. Here we discuss the results and outcomes of a selected group of patients with IBC who after obtaining a very good response to neoadjuvant chemotherapy or endocrine therapy were treated by BCT and we compare these with other recent publications on this topic. Our data show that patients treated by BCT did not have worse outcomes than patients treated with mastectomy. Importantly other series published recently support our conclusions. Another important observation is that response in estrogen receptor (ER) rich IBC is seen with neoadjuvant endocrine treatment and so not everyone with IBC needs to have neoadjuvant chemotherapy. In conclusion, patients with one or more well defined and localised breast masses and IBC may be suitable for BCT after a major response to neoadjuvant therapy and for these patients BCT should now be considered a viable option.
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Affiliation(s)
- Monika Brzezinska
- Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - J Michael Dixon
- Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK
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16
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Copson E, Shaaban AM, Maishman T, Moseley PM, McKenzie H, Bradbury J, Borley A, Brzezinska M, Chan SYT, Ching J, Cutress RI, Danial I, Dall B, Kerin M, Lowery AJ, Macpherson IR, Romics L, Sawyer E, Sharmat N, Sircar T, Vidya R, Pan Y, Rea D, Jones L, Eccles DM, Berditchevski F. The presentation, management and outcome of inflammatory breast cancer cases in the UK: Data from a multi-centre retrospective review. Breast 2018; 42:133-141. [PMID: 30278369 DOI: 10.1016/j.breast.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Inflammatory Breast cancer (IBC) is a rare but aggressive form of breast cancer. Its incidence and behaviour in the UK is poorly characterised. We collected retrospective data from hospitals in the UK and Ireland to describe the presentation, pathology, treatment and clinical course of IBC in the UK. MATERIALS AND METHODS Patients with IBC diagnosed between 1997-2014 at fourteen UK and Irish hospitals were identified from local breast unit databases. Patient characteristics, tumour pathology and stage, and details of surgical, systemic and radiotherapy treatment and follow-up data were collected from electronic patient records and medical notes. RESULT This retrospective review identified 445 patients with IBC accounting for 0.4-1.8% of invasive breast cancer cases. Median follow-up was 4.2 years. 53.2% of tumours were grade 3, 56.2% were oestrogen receptor positive, 31.3% were HER2 positive and 25.1% were triple negative. 20.7% of patients had distant metastases at presentation. Despite trimodality treatment in 86.4%, 40.1% of stage III patients developed distant metastases. Five-year overall survival (OS) was 61.0% for stage III and 21.4% for stage IV patients. CONCLUSIONS This is the largest series of UK IBC patients reported to date. It indicates a lower incidence than in American series, but confirms that IBC has a high risk of recurrence with poor survival despite contemporary multi-modality therapy. A national strategy is required to facilitate translational research into this aggressive disease.
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Affiliation(s)
- E Copson
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.
| | - A M Shaaban
- Department of Histopathology and University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW, UK
| | - T Maishman
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - P M Moseley
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - H McKenzie
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - J Bradbury
- Department of Oncology, Salisbury NHS Foundation Trust, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, SP2 8BJ, UK
| | - A Borley
- Velindre Cancer Centre, Whitchurch, Cardiff, CF14 2TL, UK
| | - M Brzezinska
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Crewe Road South Edinburgh, EH4 2XU, UK
| | - S Y T Chan
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - J Ching
- Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, BH15 2JB, UK
| | - R I Cutress
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - I Danial
- Department of Histopathology and University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW, UK
| | - B Dall
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Leeds Teaching Hospitals NHS Trust, Becket Street, Leeds, LS9 7TF, UK
| | - M Kerin
- The Lambe Institute for Translational Research, National University of Ireland & University Hospital Galway, Galway, Ireland
| | - A J Lowery
- The Lambe Institute for Translational Research, National University of Ireland & University Hospital Galway, Galway, Ireland
| | - I R Macpherson
- Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1QH, UK
| | - L Romics
- Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1QH, UK
| | - E Sawyer
- Research Oncology, Division of Cancer Studies, Guy's Hospital, King's College London, London, SE1 9RT, UK
| | - N Sharmat
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Leeds Teaching Hospitals NHS Trust, Becket Street, Leeds, LS9 7TF, UK
| | - T Sircar
- Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - R Vidya
- Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - Y Pan
- Centre for Computational Biology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - D Rea
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - L Jones
- Barts NHS Trust and Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - D M Eccles
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - F Berditchevski
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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17
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Inflammatory breast cancer-importance of breast imaging. Eur J Surg Oncol 2018; 44:1135-1138. [DOI: 10.1016/j.ejso.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/23/2022] Open
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18
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Cserni G, Charafe-Jauffret E, van Diest P. Inflammatory breast cancer: The pathologists' perspective. Eur J Surg Oncol 2018; 44:1128-1134. [DOI: 10.1016/j.ejso.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 12/20/2022] Open
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19
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Rafnsdóttir SL, Audisio RA. Inflammatory Breast Cancer: What surgeons need to know. Eur J Surg Oncol 2018; 44:1139-1141. [PMID: 29954638 DOI: 10.1016/j.ejso.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/06/2018] [Indexed: 01/09/2023] Open
Abstract
Strict criteria to identify Inflammatory Breast Cancer (IBC) have been made available - these are based on pathological as well as clinical observations. It is mandatory to confirm the criteria used in any further report. Scientific evidence accumulated so far is confusing, and unclear therefore no hard conclusion can be drawn from the available literature on the management of IBC. The advent of new medications results into an up-to-date management and different outcomes. It is mandatory to follow these criteria if reliable guidelines are to be made available in the next future.
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Affiliation(s)
- Svanheiður Lóa Rafnsdóttir
- Oncoplastic Breast Surgery, Department of Surgery, Landspitali University Hospital, 13-A Hringbraut, IS-101, Reykjavik, Iceland; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Blå Stråket 5, 413 45, Göteborg, Sweden.
| | - Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Blå Stråket 5, 413 45, Göteborg, Sweden.
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20
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Audisio RA. Inflammatory Breast Cancer: Updates on diagnosis and treatment options. Eur J Surg Oncol 2018; 44:1127. [PMID: 29945751 DOI: 10.1016/j.ejso.2018.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Riccardo A Audisio
- Department of Surgery, Institute of Clinical Sciences, Blå Stråket 5, Sahlgrenska University Hospital, 41345, Göteborg, Sweden.
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21
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Orecchia R. Radiation therapy for inflammatory breast cancer. Eur J Surg Oncol 2018; 44:1148-1150. [PMID: 29853159 DOI: 10.1016/j.ejso.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022] Open
Abstract
Inflammatory Breast Cancer (IBC) is a rare and very aggressive breast cancer, still associated with poor prognosis. Therefore, management of IBC requires carefully integrated care, and ideally, patients should be evaluated in a multidisciplinary team from the beginning, to identify the best treatment strategy. IBC is usually unresectable at presentation, and neo-adjuvant systemic therapy is considered the standard of care. Response to the primary treatment, especially pathological complete response (pCR), is important to move forward to definitive local therapy with the goal to improve survival. In any case, regardless the response to neo-adjuvant therapy, surgery and radiotherapy should administered to ensure a better loco-regional tumor control. Mastectomy with axillary lymph node dissection followed by chest wall and regional nodal radiotherapy is the most frequent approach, and whether breast-conserving surgery could be preferable in some selected groups of patients with clinical complete response is still a debated question. Radiotherapy alone has recommended only in cases of persistent unresectability. To date, the approach remains as established in the current recommendations, with the best option for trimodality treatment, and further studies clearly warranted.
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22
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Ueno NT, Espinosa Fernandez JR, Cristofanilli M, Overmoyer B, Rea D, Berdichevski F, El-Shinawi M, Bellon J, Le-Petross HT, Lucci A, Babiera G, DeSnyder SM, Teshome M, Chang E, Lim B, Krishnamurthy S, Stauder MC, Parmar S, Mohamed MM, Alexander A, Valero V, Woodward WA. International Consensus on the Clinical Management of Inflammatory Breast Cancer from the Morgan Welch Inflammatory Breast Cancer Research Program 10th Anniversary Conference. J Cancer 2018; 9:1437-1447. [PMID: 29721054 PMCID: PMC5929089 DOI: 10.7150/jca.23969] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/29/2018] [Indexed: 01/17/2023] Open
Abstract
National and international experts in inflammatory breast cancer (IBC) from high-volume centers treating IBC recently convened at the 10th Anniversary Conference of the Morgan Welch Inflammatory Breast Cancer Research Program at The University of Texas MD Anderson Cancer Center in Houston Texas. A consensus on the clinical management of patients with IBC was discussed, summarized, and subsequently reviewed. All participants at the conference (patients, advocates, researchers, trainees, and clinicians) were queried using the MDRing electronic survey on key management issues. A summary of the expert consensus and participant voting is presented. Bilateral breast and nodal evaluation, breast magnetic resonance imaging, positron emission tomography/computed tomography, and medical photographs were endorsed as optimal. Neoadjuvant systemic therapy, modified radical mastectomy and level I and II ipsilateral axillary node dissection, post-mastectomy radiotherapy, adjuvant targeted therapy and hormonal therapy as indicated, and delayed reconstruction were agreed-upon fundamental premises of standard non-protocol-based treatment for IBC. Consideration for local-regional therapy in de novo stage IV IBC was endorsed to provide local control whenever feasible. Variation across centers and special circumstances were discussed.
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Affiliation(s)
- Naoto T Ueno
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Rodrigo Espinosa Fernandez
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Massimo Cristofanilli
- Department of Medicine, Division of Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Evanston, Illinois, USA
| | - Beth Overmoyer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dan Rea
- School of Cancer Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Fedor Berdichevski
- School of Cancer Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Mohamad El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Jennifer Bellon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Huong T Le-Petross
- Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt
| | - Anthony Lucci
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gildy Babiera
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah M DeSnyder
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mediget Teshome
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Edward Chang
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bora Lim
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Savitri Krishnamurthy
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael C Stauder
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Simrit Parmar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mona M Mohamed
- Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt
| | - Angela Alexander
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vicente Valero
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendy A Woodward
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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23
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Chen H, Wu K, Wang M, Wang F, Zhang M, Zhang P. Reply to Woodward et al.: A standard mastectomy should not be the only recommended breast surgical treatment for non-metastatic inflammatory breast cancer. Breast 2018; 39:149-150. [PMID: 29510949 DOI: 10.1016/j.breast.2018.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Hongliang Chen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Kejin Wu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China.
| | - Maoli Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Fuwen Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Mingdi Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Peng Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
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24
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Storr SJ, Zhang S, Perren T, Lansdown M, Fatayer H, Sharma N, Gahlaut R, Shaaban A, Martin SG. The calpain system is associated with survival of breast cancer patients with large but operable inflammatory and non-inflammatory tumours treated with neoadjuvant chemotherapy. Oncotarget 2018; 7:47927-47937. [PMID: 27323818 PMCID: PMC5216989 DOI: 10.18632/oncotarget.10066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/29/2016] [Indexed: 01/16/2023] Open
Abstract
The calpains are a family of intracellular cysteine proteases that function in a variety of important cellular functions, including cell signalling, motility, apoptosis and survival. In early invasive breast cancer expression of calpain-1, calpain-2 and their inhibitor, calpastatin, have been associated with clinical outcome and clinicopathological factors.The expression of calpain-1, calpain-2 and calpastatin was determined using immunohistochemistry on core biopsy samples, in a cohort of large but operable inflammatory and non-inflammatory primary breast cancer patients treated with neoadjuvant chemotherapy. Information on treatment and prognostic variables together with long-term clinical follow-up was available for these patients. Diagnostic pre-chemotherapy core biopsy samples and surgically excised specimens were available for analysis.Expression of calpastatin, calpain-1 or calpain-2 in the core biopsies was not associated with breast cancer specific survival in the total patient cohort; however, in patients with non-inflammatory breast cancer, high calpastatin expression was significantly associated with adverse breast cancer-specific survival (P=0.035), as was low calpain-2 expression (P=0.031). Low calpastatin expression was significantly associated with adverse breast cancer-specific survival of the inflammatory breast cancer patients (P=0.020), as was low calpain-1 expression (P=0.003).In conclusion, high calpain-2 and low calpastatin expression is associated with improved breast cancer-specific survival in non-inflammatory large but operable primary breast cancer treated with neoadjuvant chemotherapy. In inflammatory cases, high calpain-1 and high calpastatin expression is associated with improved breast cancer-specific survival. Determining the expression of these proteins may be of clinical relevance. Further validation, in multi-centre cohorts of breast cancer patients treated with neoadjuvant chemotherapy, is warranted.
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Affiliation(s)
- Sarah J Storr
- Department of Clinical Oncology, Division of Cancer and Stem Cells, University of Nottingham, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, NG5 1PB, UK
| | - Siwei Zhang
- Department of Clinical Oncology, Division of Cancer and Stem Cells, University of Nottingham, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, NG5 1PB, UK
| | - Tim Perren
- Leeds Institute of Cancer Medicine and Pathology, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK.,Department of Breast Surgery, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Mark Lansdown
- Leeds Institute of Cancer Medicine and Pathology, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Hiba Fatayer
- Department of Breast Surgery, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Nisha Sharma
- Breast Screening Unit Leeds/Wakefield, Seacroft Hospital, Leeds, LS14 6UH, UK
| | - Renu Gahlaut
- Leeds Institute of Cancer Medicine and Pathology, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Abeer Shaaban
- Leeds Institute of Cancer Medicine and Pathology, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK.,Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre and The University of Birmingham, Birmingham, B15 2TH, UK
| | - Stewart G Martin
- Department of Clinical Oncology, Division of Cancer and Stem Cells, University of Nottingham, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, NG5 1PB, UK
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25
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[Radiation therapy in inflammatory breast cancer]. Bull Cancer 2018; 105:415-425. [PMID: 29475596 DOI: 10.1016/j.bulcan.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inflammatory breast cancer accounts for 1-5% of all breast cancers. It is associated with a poor prognosis, because of an increased risk to develop metastases in comparison with all breast malignancies. The treatment is multimodal. We have evaluated the role of radiotherapy: indications, techniques and impact for local control and overall survival. METHOD The series of the literature with more than 40 patients irradiated for inflammatory breast cancer published since 1995 were analyzed. RESULTS Chemotherapy was always delivered first. Adjuvant radiotherapy was associated with local control and overall survival at 10 years of 63-92% and 51-64 respectively. Without surgery, local control was 65% and overal survival 38% at 10years. Results of concomitant radiochemotherapy were reported: the studies were heterogenous. Modalities of radiotherapy were detailed with respect to dose and fractionation, target-volumes and technical considerations (including bolus). CONCLUSION The multimodal strategy comprises systematically radiotherapy with an evaluation of tumor response to maximise resecability.
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26
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Krug D, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Piroth MD, Sedlmayer F, Souchon R, Wenz F, Sauer R. Individualization of post-mastectomy radiotherapy and regional nodal irradiation based on treatment response after neoadjuvant chemotherapy for breast cancer. Strahlenther Onkol 2018; 194:607-618. [DOI: 10.1007/s00066-018-1270-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 01/08/2023]
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27
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Costa R, Santa-Maria CA, Rossi G, Carneiro BA, Chae YK, Gradishar WJ, Giles FJ, Cristofanilli M. Developmental therapeutics for inflammatory breast cancer: Biology and translational directions. Oncotarget 2017; 8:12417-12432. [PMID: 27926493 PMCID: PMC5355355 DOI: 10.18632/oncotarget.13778] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/07/2016] [Indexed: 12/16/2022] Open
Abstract
Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer, which accounts for approximately 3% of cases of breast malignancies. Diagnosis relies largely on its clinical presentation, and despite a characteristic phenotype, underlying molecular mechanisms are poorly understood. Unique clinical presentation indicates that IBC is a distinct clinical and biological entity when compared to non-IBC. Biological understanding of non-IBC has been extrapolated into IBC and targeted therapies for HER2 positive (HER2+) and hormonal receptor positive non-IBC led to improved patient outcomes in the recent years. This manuscript reviews recent discoveries related to the underlying biology of IBC, clinical progress to date and suggests rational approaches for investigational therapies.
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Affiliation(s)
- Ricardo Costa
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, United States of America
| | - Cesar A Santa-Maria
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, United States of America.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States of America
| | - Giovanna Rossi
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States of America
| | - Benedito A Carneiro
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, United States of America.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States of America
| | - Young Kwang Chae
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, United States of America.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States of America
| | - William J Gradishar
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, United States of America.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States of America
| | - Francis J Giles
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, United States of America.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States of America
| | - Massimo Cristofanilli
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, United States of America.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, United States of America
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Rosso KJ, Ueno NT, Woodward WA, Lucci A. In response to “outcomes of patients with inflammatory breast cancer treated by breast conserving surgery”: the argument against breast conservation and sentinel lymph node biopsy in IBC. Breast Cancer Res Treat 2017; 165:779-781. [DOI: 10.1007/s10549-017-4337-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/08/2017] [Indexed: 11/28/2022]
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Richardson T, Cottier F. An unexpected diagnosis of breast malignancy. Ann R Coll Surg Engl 2017; 99:e180-e182. [PMID: 28660825 PMCID: PMC5696988 DOI: 10.1308/rcsann.2017.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/22/2022] Open
Abstract
Inflammatory breast cancer constitutes 5% of all breast cancer diagnoses. Diagnosis is based on clinical signs including skin changes, erythema and oedema, together with rapid progression and involvement of more than one-third of the affected breast. It is an aggressive tumour with great metastatic potential, metastases being present in 30% of patients at first presentation. Primary non-Hodgkin's lymphoma of the breast is rare but is well reported. It accounts for 0.5% of all breast malignancies and 1% of all non-Hodgkin's diagnoses. Prognosis of primary breast lymphoma varies depending on the stage of disease with stage IE having a 5-year survival rate of 78-83% and stage IIE having a 5-year survival rate of 20-57%. We present a rare case of non-Hodgkin's lymphoma mimicking an inflammatory breast cancer. The aim of this case report is to highlight an unusual presentation of non-Hodgkin's lymphoma and the diagnostic difficulties that arise.
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Affiliation(s)
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- Weaver Vale General Practice , Runcorn , UK
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A standard mastectomy should not be the only recommended breast surgical treatment for non-metastatic inflammatory breast cancer: A large population-based study in the Surveillance, Epidemiology, and End Results database 18. Breast 2017. [PMID: 28649032 DOI: 10.1016/j.breast.2017.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Standard mastectomy has long been the recommended breast surgical treatment for non-metastatic inflammatory breast cancer (IBC). The objective of this population-based study was to evaluate the significance of various breast surgical treatments for this highly aggressive subtype. METHODS The Surveillance, Epidemiology, and End Results program registry was searched to identify women with non-metastatic IBC receiving standard treatment including breast surgery, radiation therapy and chemotherapy diagnosed between 1998 and 2013. Comparisons of the proportions of various breast surgery procedures over the years were performed using Pearson's chi-square test. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan-Meier product limit method and compared across groups using the log-rank statistic. Cox models were then fitted to compare the association between various breast surgical procedures and BCSS or OS after adjusting for patient and tumor characteristics. RESULTS A total of 3374 cases were identified. Over the years, the proportion of contralateral prophylactic mastectomy (CPM), breast reconstruction and both were increasing. The proportion of implant-based reconstruction was also increasing with no difference in survival compared with other types of reconstruction. There was no statistically significant difference in BCSS or OS among various breast surgery treatments, such as breast conserving surgery, CPM, breast reconstruction and standard unilateral mastectomy. CONCLUSIONS Breast surgery is of great significance to the clinical outcome of IBC. Standard mastectomy should not be the only recommended breast surgical treatment.
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The Innate Immune Response in Myocardial Infarction, Repair, and Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1003:251-272. [PMID: 28667562 DOI: 10.1007/978-3-319-57613-8_12] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Following myocardial infarction (MI), resident innate immune cells such as macrophages, innate lymphoid cells, and mast cells rapidly coordinate their function to contain inflammation by removing dying cells and promoting cardiomyocyte replenishment. To sustain local tissue repair functions, hematopoietic progenitors are mobilized from the bone marrow to the spleen to generate subsequent myeloid cells such as monocytes and neutrophils, which are rapidly recruited at the site of MI. A finely tuned balance between local adaptation and recruitment controls the overall outcome of the cardiac tissue regeneration versus repair and scar formation.In this chapter, the (potential) roles of the innate immune system residing in the heart are discussed in the context of recent findings about macrophage ontogeny and their homeostasis with circulating monocytes during cardiac tissue growth and after myocardial infarction. Their interactions with other members of the innate immune system are also discussed with a particular emphasis on the potential involvement of mast cells and innate lymphoid cells during MI, largely underestimated until recently. Understanding the development and the functions of the different protagonists responding to MI as well as their potential cross talk could help design new strategies for regenerative medicine intervention.
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Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery. Breast Cancer Res Treat 2016; 160:387-391. [PMID: 27757718 DOI: 10.1007/s10549-016-4017-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Inflammatory breast cancer (IBC) is rare and associated with a poor prognosis. Following neoadjuvant chemotherapy or endocrine therapy, the multidisciplinary team selected a small number of patients for breast-conservation therapy (BCT). The aim of this study was to determine the outcome of IBC patients treated with BCT in Edinburgh. METHODS Between January 1999 and December 2013, thirty-five women with IBC were treated by BCT. The median follow-up was 80 months. RESULTS The 5-year actuarial survival for the 35 patients was 70.3 %. Median survival for 20 neoadjuvant chemotherapy patients was 12.9 years (95 % CI 7.6, 18.1), and for 14 patient neoadjuvant endocrine therapy patients, it was 11.8 years (95 % CI 1.1, 22.6) (p = 0.34). Five patients developed locoregional recurrence (LRR) between 11 and 72 months after BCT (median 37 months). Three had breast only recurrence, one patient had both breast and axillary recurrence, and one developed axillary recurrence. The 5-year LR-free survival was 87.5 % (95 % CI 76.0, 99.0). In 4 of the 5 patients with LRR, systemic metastases were diagnosed within 6 months and survival post-LRR in these 4 patients was short. CONCLUSION IBC is not an absolute contraindication to BCT. LRR in patients after BCT appears part of widespread recurrent disease rather than inadequate local treatment. Multicentre data should be collected to confirm that women with IBC who have a good response to systemic therapy may be offered BCT in the knowledge that in a larger series our observations are confirmed.
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