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Management of inflammatory breast cancer

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Abstract

Inflammatory breast cancer (IBC) is a rare but often fatal disease. This review discusses the following conclusions: (1) The diagnosis IBC is based on the clinical triad of erythema, ridging with peau d'orange, and rapid onset. The importance of histologic evidence of dermal lymphatic involvement is controversial. (2) Combining doxorubicin-containing chemotherapy with mastectomy or radiation therapy improves survival over that achieved with mastectomy or irradiation alone. (3) Mastectomy after induction chemotherapy may not improve survival or decrease locoregional recurrence rates, but the surgery does provide important prognostic information on treatment response and enables use of a lower radiation dose afterward, which results in reduced long-term complications. (4) The optimal number of cycles and dose intensity of chemotherapy for IBC remain undefined.

Résumé

Le cancer du sein inflammatoire (CSI) est rare mais souvent fatal. Les auteurs concluent que: 1) le diagnostic du CSI est basé sur la triade clinique: érythème, phénomène de peau d'orange et début rapide. L'importance de l'envahissement ganglionnaire est controversée; 2) la chimiothérapie combinée, comportant au moins la doxorubicine, associée à une mastectomie ou à la radiothérapie, améliore le pronostic par rapport à la mastectomie ou la radiothérapie seules; 3) la mastectomie après chimiothérapie d'induction peut parfois ne pas améliorer le pronostic ni diminuer le taux de récidives locorégionales. La chirurgie fournit, cependant, des données essentielles au plan pronostic, basées aussi sur la réponse thérapeutique et permet d'utiliser des doses de radiothérapie moindres par la suite, réduisant ainsi le taux de complications à long terme; 4) le nombre de cycles et les doses de chimiothérapie optimaux ne sont pas encore bien définis dans le CSI.

Resumen

El cáncer inflamatorio del seno (CIS) es una enfermedad rara pero generamente letal. La presente revisión se refiere a las siguientes conclusiones: (1) El diagnóstico del CIS se fundamenta en la tríada de eritema, “piel de naranja” y un comienzo rápido de la enfermedad. La importancia de la evidencia histológica de invasión de los linfáticos dérmicos, como criterio diagnóstico, es motivo de controversia. (2) La combinación de un régimen quimioterápico que contenga doxorrubicina con mastectomía o radioterapia mejora la sobrevida, en comparación con lo que logran la mastectomía o la irradiación solas. (3) Aunque es posible que con la mastectomía que se practica luego de la quimioterapia de inducción no se logre mejoría de la sobrevida ne disminuir las tasas de recurrencial local-regional, la cirugía provee importante información de carácter pronóstico en relación a la respuesta al tratamiento y permite, ulteriormente, el uso de dosis más bajas de irradicación, lo cual resulta en una reducción de las complicaciones a largo plazo. (4) El número óptimo de ciclos y la intensidad de las dosis de quimioterapia en el CIS todavía no han sido definidas.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 106, 77030, Houston, Texas, USA

    Sonja E. Singletary M.D. & Frederick C. Ames M.D.

  2. Department of Breast and Gynecologic Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, 77030, Houston, Texas, USA

    Aman U. Buzdar

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  1. Sonja E. Singletary M.D.
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  2. Frederick C. Ames M.D.
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  3. Aman U. Buzdar
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Singletary, S.E., Ames, F.C. & Buzdar, A.U. Management of inflammatory breast cancer. World J. Surg. 18, 87–92 (1994). https://doi.org/10.1007/BF00348197

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