Low Rates of Local-Regional Recurrence Among Inflammatory Breast Cancer Patients After Contemporary Trimodal Therapy

• Published in: Annals of surgical oncology 2023-10, Vol.30 (10), p.6232-6240
• Main Authors: Adesoye, Taiwo, Everidge, Shlermine, Chen, Jennifer, Sun, Susie X., Teshome, Mediget, Valero, Vicente, Woodward, Wendy A., Lucci, Anthony
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Oncology; Cancer therapies; Chemotherapy; Chest; Inflammation; Mastectomy; Medicine; Medicine & Public Health; Metastases; Metastasis; Multivariate analysis; Oncology; Radiation; Radiation therapy; Surgery; Surgical Oncology; Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-13906-5

Background Inflammatory breast cancer (IBC) represents a rare (2–3 %) but aggressive subset of breast cancer with a historically reported 5-year overall survival rate of 50 % and a 3-year local-regional recurrence (LRR) rate of 20 %. This study aimed to evaluate long-term LRR in a contemporary cohort of non-metastatic IBC patients undergoing trimodal therapy at a single institution and identify factors associated with local and distant failure. Methods The study identified 262 patients with non-metastatic IBC who received trimodal therapy (neoadjuvant chemotherapy, modified radical mastectomy, adjuvant radiation) from an institutional prospective database (2007–2019). Long-term outcomes of local-regional and distant metastasis were reported. Survival outcomes were analyzed using the Cox proportional hazards regression model. Results The median age at diagnosis was 52 years, and the median follow-up period was 5.1 years. In this cohort, 82 (31.3 %) patients achieved a pathologic complete response (pCR) in the breast and axilla. Local-regional recurrence was observed in 18 (6.9 %) patients (11 isolated to the chest wall, 4 isolated to regional nodes, and 3 involving chest wall and ipsilateral axillary nodes). Distant metastasis was observed in 92 (35.1 %) patients. During the follow-up period, 90 deaths occurred. In the multivariate analysis, pCR was associated with improved disease-free survival (hazard ratio [HR], 0.26; 95 % confidence interval [CI], 0.13–0.51; p  = 0.001) and overall survival (HR, 0.31; 95 % CI, 0.15–0.65;  p = 002). Conclusions During a median follow-up period longer than 5 years, the local-regional relapse rate for the IBC patients treated with contemporary trimodal therapy was 6.9%, similar to that for the non-IBC patients. After chemotherapy, surgical resection with modified radical mastectomy to negative margins and postmastectomy radiation therapy resulted in excellent long-term local-regional control.