Multimodal treatment for inflammatory breast cancer

Thoms, William W.; McNeese, Marsha D.; Fletcher, Gilbert H.; Buzdar, Aman U.; Singletary, S. Eva; Oswald, Mary Jane

doi:10.1016/0360-3016(89)90060-6

Cited by 97 publications

(41 citation statements)

References 18 publications

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“…Early in that period, we moved from a once-daily fractionation schema to an accelerated hyperfractionated approach (15,19); later we escalated the total radiation dose from 60 Gy to 66 Gy (8). In our previous report updating our experience with IBC, Liao et al (8) reviewed the results of 115 patients with IBC and concluded that escalating the dose from 60 Gy to 66 Gy delivered by twice-daily fractionation significantly improved the 5-year LRC rate (58% vs. 84%, respectively; p = 0.04).…”

Section: Discussionmentioning

confidence: 99%

“…Tissue equivalent bolus (3-to 5-mm thick) was placed on the chest wall every treatment for the first 10 treatments, every other treatment for the next 10 treatments, and then as needed based on the clinical response of the skin overlying the chest wall. The goal of the bolus schedule was to cause brisk erythema with dry desquamation, which we had reported previously to correlate with the highest probability of LRC (15).…”

Section: Treatmentmentioning

confidence: 99%

“…Over the past three decades, the locoregional treatment strategy for patients with IBC has evolved. Initially radiation was used alone (14); but after systemic treatments became available, neoadjuvant chemotherapy followed by mastectomy and radiation became the standard (15).…”

Section: Introductionmentioning

confidence: 99%

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Locoregional Treatment Outcomes After Multimodality Management of Inflammatory Breast Cancer

Bristol

Woodward

Strom

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

129

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Purpose-The aims of this study were to determine outcomes for patients with inflammatory breast cancer (IBC) treated with multimodality therapy, to identify factors associated with locoregional recurrence, and to determine which patients may benefit from radiation dose escalation. Results-The 192 patients who were able to complete the planned course of chemotherapy, mastectomy, and postmastectomy radiation had significantly better outcomes than the 64 patients who did not. The respective 5-year outcome rates were: locoregional control (84% vs. 51%), distant metastasis-free survival (47% vs. 20%), and overall survival (51% vs. 24%) (p < 0.0001 for all comparisons). Univariate factors significantly associated with locoregional control in the patients who completed plan treatment were response to neoadjuvant chemotherapy, surgical margin status, number of involved lymph nodes, and use of taxanes. Increasing the total chest-wall dose of postmastectomy radiation from 60 Gy to 66 Gy significantly improved locoregional control for patients who experienced less than a partial response to chemotherapy, patients with positive, close, or unknown margins, and patients <45 years of age. Methods and Materials-WeConclusions-Patients with IBC who are able to complete treatment with chemotherapy, mastectomy, and postmastectomy radiation have a high probability of locoregional control.

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Locoregional Treatment Outcomes After Multimodality Management of Inflammatory Breast Cancer

Bristol

Woodward

Strom

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

129

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“…In a retrospective study of 61 inflammatory breast cancer patients, Thomas et al (5) found the most common site of failure was in the chest wall, and, specifically, failure was most common in patients who did not achieve brisk erythema or moist desquamation. Hence, to ensure sufficient superficial coverage, tissue‐equivalent bolus is commonly used for a portion of the treatment until moderate to brisk erythema is observed.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric assessment of brass mesh bolus for postmastectomy photon radiotherapy

Manger

Paxton

Cerviño

2016

J Applied Clin Med Phys

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Brass mesh bolus has been shown to be an acceptable substitute for tissue‐equivalent bolus to increase superficial dose for chest wall tangent photon radiotherapy. This work investigated the increase in surface dose, the change in the dose at depth, and the safety implications of higher energy photon beams when using brass mesh bolus for postmastectomy chest wall radiotherapy. A photon tangent plan was delivered to a thorax phantom, and the superficial dose ranged from 40%–72% of prescription dose with no bolus. The surface dose increased to 75%–110% of prescription dose with brass mesh bolus and 85%–109% of prescription dose with tissue‐equivalent bolus. It was also found that the dose at depth when using brass mesh bolus is comparable to that measured with no bolus for en face and oblique incidence. Monte Carlo calculations were used to assess the photoneutron production from brass mesh bolus used with 15 MV and 24 MV photon beams. The effective dose from photoneutrons was approximated and found to be relatively small, yet not negligible. Activation products generated by these photoneutrons, the surface dose rate due to the activation products, and the half‐life of the activation products were also considered in this work. The authors conclude that brass mesh bolus is a reasonable alternative to tissue‐equivalent bolus, and it may be used with high‐energy beam; but one should be aware of the potential increased effective dose to staff and patients due to the activation products produced by photoneutrons.PACS number(s): 87.53.Kn, 87.55.K

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“…1,2 The usual sequence of treatment involves induction chemotherapy followed by surgery, radiation therapy, further chemotherapy and hormonal therapy resulting in 5 year event-free survivals (EFS) of approximately 30%. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of induction chemotherapy and local-regional radioCorrespondence: Dr CD Buckner, Response Oncology, Inc., 600 Broadway, Suite 112, Seattle, WA 98122, USA Received 18 January 1999; accepted 15 April 1999 therapy has decreased local progression of disease but the majority of patients relapse at distant sites making eradication of microscopic metastatic disease the major challenge.The potential value of high-dose chemotherapy (HDC) with hematopoietic stem cell support in patients with operable high-risk stage II-III non-inflammatory breast cancer has been reported. [19][20][21][22][23][24][25][26] Evaluation of HDC with stem cell support in patients with IBC is a logical extension of these studies.…”

mentioning

confidence: 99%

High-dose chemotherapy with peripheral blood stem cell support for stage IIIB inflammatory carcinoma of the breast

Schwartzberg

Weaver

Lewkow

et al. 1999

Bone Marrow Transplant

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Summary:The purpose of this study was to determine outcomes for 56 patients with inflammatory breast cancer (IBC) receiving high-dose chemotherapy (HDC) with cyclophosphamide, thiotepa and carboplatin (CTCb) with peripheral blood stem cell (PBSC) support. All patients received the same total amount of chemotherapy but there were differences in the sequence of therapy: 15 received induction chemotherapy, chemotherapy mobilization of PBSC and CTCb after surgery (adjuvant group) while 41 received induction chemotherapy with (n = 17) or without (n = 24) chemotherapy for mobilization of PBSC prior to surgery and CTCb after surgery (neoadjuvant group). Median time from diagnosis to HDC was 5.5 months (range 3.5-12.5). Fifty-one patients (91%) required admission to the hospital following HDC for a median of 11 days (range 5-25). There were two (4%) infectious deaths after HDC. Twenty-four patients (43%) have relapsed at a median of 18 months (range 8-50) from diagnosis resulting in death in 34%. The probabilities of overall (OS) and event-free survival (EFS) at 3 years for all 56 patients were 0.72 and 0.53, respectively, with a median followup of 44 months (range 15-76) from diagnosis. There were no differences in OS, EFS or patterns of relapse between patients in the adjuvant or neoadjuvant groups. These sequences of combined modality therapy incorporating HDC are comparable or superior to other intensive approaches for the treatment of IBC. Further improvements will be necessary to decrease systemic recurrences. Keywords: high-dose therapy; inflammatory breast cancer Multi-modality therapy is now the standard of care for patients with inflammatory breast cancer (IBC). 1,2 The usual sequence of treatment involves induction chemotherapy followed by surgery, radiation therapy, further chemotherapy and hormonal therapy resulting in 5 year event-free survivals (EFS) of approximately 30%. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of induction chemotherapy and local-regional radioCorrespondence: Dr CD Buckner, Response Oncology, Inc., 600 Broadway, Suite 112, Seattle, WA 98122, USA Received 18 January 1999; accepted 15 April 1999 therapy has decreased local progression of disease but the majority of patients relapse at distant sites making eradication of microscopic metastatic disease the major challenge.The potential value of high-dose chemotherapy (HDC) with hematopoietic stem cell support in patients with operable high-risk stage II-III non-inflammatory breast cancer has been reported. [19][20][21][22][23][24][25][26] Evaluation of HDC with stem cell support in patients with IBC is a logical extension of these studies.Results of autologous bone marrow (BM) transplantation for patients with IBC have been included in summaries of transplant results 27,28 and reported by the International Bone Marrow Transplant Registry. 23,29 Recently, there have been two single-center reports of outcomes for patients with stage IIIB IBC with HDC with BM or peripheral blood stem cell (PBSC) support. 30,31 These s...

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Multimodal treatment for inflammatory breast cancer

Cited by 97 publications

References 18 publications

Locoregional Treatment Outcomes After Multimodality Management of Inflammatory Breast Cancer

Locoregional Treatment Outcomes After Multimodality Management of Inflammatory Breast Cancer

Dosimetric assessment of brass mesh bolus for postmastectomy photon radiotherapy

High-dose chemotherapy with peripheral blood stem cell support for stage IIIB inflammatory carcinoma of the breast

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