Accelerated superfractionated radiotherapy for inflammatory breast carcinoma: Complete response predicts outcome and allows for breast conservation

Douglas W. Arthur, Rupert K. Schmidt-Ullrich, Richard B. Friedman, David E. Wazer, Lisa A. Kachnic, Cyrus Amir, Harry D. Bear, Mary Helen Hackney, Thomas J Smith, Walter Lawrence

Research output: Contribution to journalArticle

Abstract

Purpose: Chemotherapy and accelerated superfractionated radiotherapy were prospectively applied for inflammatory breast carcinoma with the intent of breast conservation. The efficacy, failure patterns, and patient tolerance utilizing this approach were analyzed. Methods and Materials: Between 1983 and 1996, 52 patients with inflammatory breast carcinoma presented the Medical College of Virginia Hospitals of VCU and the New England Medical Center. Thirty-eight of the patients were jointly evaluated in multidisciplinary breast clinics and managed according to a defined prospectively applied treatment policy. Patients received induction chemotherapy, accelerated superfractionated radiotherapy, selected use of mastectomy, and concluded with additional chemotherapy. The majority were treatment with 1.5 Gy twice daily to field arrangements covering the entire breast and regional lymphatics. An addition 18-21 Gy was then delivered to the breast and clinically involved nodal regions. Total dose to clinically involve areas was 63-66 Gy. Following chemoradiotherapy, patients were evaluated with physical examination, mammogram, and fine needle aspiration x 3. Mastectomy was reserved for those patients with evidence of persistent or progressive disease in the involved breast. All patients received additional chemotherapy. Results: Median age was 51 years. Median follow-up was 23.9 months (6-86) months. The breast preservation rate at the time of last follow-up was 74%. The treated breast or chest wall as the first site of failure occurred in only 13%, and the ultimate local control rate with the selected use of mastectomy was 74%. Ten patient underwent mastectomy, 2 of which had pathologically negative specimens despite a clinically palpable residual mass. Response to chemotherapy was predictive of treatment outcome. Of the 15 patients achieving a complete response, 87% remain locoregionally controlled without the use of mastectomy. Five-year overall survival for complete responders was 68%. This is in contrast to the 14% 5-year overall survival observed with incomplete responders. The 5-year actuarial disease- free survival and overall survival for the entire patient cohort was 11 and 33%, respectively. All patients tolerated irradiation with limited acute effects, of which all were managed conservatively. Conclusion: Our experience demonstrates that induction chemotherapy, accelerated superfractionated radiotherapy, and the selected use of mastectomy results in excellent locoregional control rates, is well tolerated, an optimizes breast preservation. Based on our present results, we recommend that a patient's response to induction chemotherapy guide the treatment approach used for locoregional disease, such that mastectomy be reserved for incomplete responders and avoided in those achieving a complete response.

Original languageEnglish (US)
Pages (from-to)289-296
Number of pages8
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume44
Issue number2
DOIs
StatePublished - May 1999
Externally publishedYes

Fingerprint

Inflammatory Breast Neoplasms
breast
conservation
radiation therapy
Breast
Radiotherapy
cancer
Mastectomy
chemotherapy
transponders
Induction Chemotherapy
Drug Therapy
induction
Survival
physical examinations
New England (US)
New England
chest
Thoracic Wall
Chemoradiotherapy

Keywords

  • Altered fractionation
  • Chemotherapy
  • Inflammatory breast carcinoma
  • Mastectomy
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Accelerated superfractionated radiotherapy for inflammatory breast carcinoma : Complete response predicts outcome and allows for breast conservation. / Arthur, Douglas W.; Schmidt-Ullrich, Rupert K.; Friedman, Richard B.; Wazer, David E.; Kachnic, Lisa A.; Amir, Cyrus; Bear, Harry D.; Hackney, Mary Helen; Smith, Thomas J; Lawrence, Walter.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 44, No. 2, 05.1999, p. 289-296.

Research output: Contribution to journalArticle

Arthur, Douglas W. ; Schmidt-Ullrich, Rupert K. ; Friedman, Richard B. ; Wazer, David E. ; Kachnic, Lisa A. ; Amir, Cyrus ; Bear, Harry D. ; Hackney, Mary Helen ; Smith, Thomas J ; Lawrence, Walter. / Accelerated superfractionated radiotherapy for inflammatory breast carcinoma : Complete response predicts outcome and allows for breast conservation. In: International Journal of Radiation Oncology, Biology, Physics. 1999 ; Vol. 44, No. 2. pp. 289-296.
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abstract = "Purpose: Chemotherapy and accelerated superfractionated radiotherapy were prospectively applied for inflammatory breast carcinoma with the intent of breast conservation. The efficacy, failure patterns, and patient tolerance utilizing this approach were analyzed. Methods and Materials: Between 1983 and 1996, 52 patients with inflammatory breast carcinoma presented the Medical College of Virginia Hospitals of VCU and the New England Medical Center. Thirty-eight of the patients were jointly evaluated in multidisciplinary breast clinics and managed according to a defined prospectively applied treatment policy. Patients received induction chemotherapy, accelerated superfractionated radiotherapy, selected use of mastectomy, and concluded with additional chemotherapy. The majority were treatment with 1.5 Gy twice daily to field arrangements covering the entire breast and regional lymphatics. An addition 18-21 Gy was then delivered to the breast and clinically involved nodal regions. Total dose to clinically involve areas was 63-66 Gy. Following chemoradiotherapy, patients were evaluated with physical examination, mammogram, and fine needle aspiration x 3. Mastectomy was reserved for those patients with evidence of persistent or progressive disease in the involved breast. All patients received additional chemotherapy. Results: Median age was 51 years. Median follow-up was 23.9 months (6-86) months. The breast preservation rate at the time of last follow-up was 74{\%}. The treated breast or chest wall as the first site of failure occurred in only 13{\%}, and the ultimate local control rate with the selected use of mastectomy was 74{\%}. Ten patient underwent mastectomy, 2 of which had pathologically negative specimens despite a clinically palpable residual mass. Response to chemotherapy was predictive of treatment outcome. Of the 15 patients achieving a complete response, 87{\%} remain locoregionally controlled without the use of mastectomy. Five-year overall survival for complete responders was 68{\%}. This is in contrast to the 14{\%} 5-year overall survival observed with incomplete responders. The 5-year actuarial disease- free survival and overall survival for the entire patient cohort was 11 and 33{\%}, respectively. All patients tolerated irradiation with limited acute effects, of which all were managed conservatively. Conclusion: Our experience demonstrates that induction chemotherapy, accelerated superfractionated radiotherapy, and the selected use of mastectomy results in excellent locoregional control rates, is well tolerated, an optimizes breast preservation. Based on our present results, we recommend that a patient's response to induction chemotherapy guide the treatment approach used for locoregional disease, such that mastectomy be reserved for incomplete responders and avoided in those achieving a complete response.",
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