What is the optimum approach to inflammatory breast carcinoma?

From the Guidelines

The optimum approach to inflammatory breast carcinoma is chemotherapy, modified radical mastectomy, and radiotherapy (option e). Inflammatory breast cancer is an aggressive form of breast cancer that requires a multimodal treatment approach. Treatment typically begins with neoadjuvant chemotherapy to reduce the tumor burden and control the disease systemically, as recommended by the 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4) 1. This is crucial because inflammatory breast cancer has a high risk of distant metastasis at presentation. Following chemotherapy, modified radical mastectomy is performed to achieve local control by removing the breast tissue and axillary lymph nodes, as suggested by the guidelines with a consensus of 95% 1. After surgery, radiotherapy is administered to the chest wall and regional lymph nodes to eradicate any remaining microscopic disease and reduce the risk of local recurrence, with a consensus of 98% for locoregional radiotherapy (chest wall and lymph nodes) even when a pathological complete response is achieved with systemic therapy 1. This trimodal approach offers the best chance for disease control and survival in patients with inflammatory breast cancer. Single-modality treatments like mastectomy alone, lumpectomy with radiation, or chemotherapy alone are inadequate for managing this aggressive disease and are associated with poor outcomes. The 3rd ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 3) also support a combined treatment modality based on a multidisciplinary approach (systemic therapy, surgery, and radiotherapy) for inflammatory breast cancer, with a level of evidence of 1 and a consensus of 93% 1.

Some key points to consider in the treatment of inflammatory breast cancer include:

• The importance of a full staging workup prior to initiation of systemic therapy, including a complete history, physical examination, lab tests, and imaging of chest and abdomen (preferably CT) and bone, as recommended by the ABC 3 guidelines with a level of evidence of 2 and a consensus of 100% 1.
• The need for systemic therapy as the initial treatment, as stated by the ABC 3 guidelines with a consensus of 100% 1.
• The recommendation for mastectomy with axillary dissection in almost all cases, even when there is a good response to primary systemic therapy, as suggested by the ABC 4 guidelines with a consensus of 95% 1.
• The requirement for locoregional radiotherapy (chest wall and lymph nodes) even when a pathological complete response is achieved with systemic therapy, as recommended by the ABC 4 guidelines with a consensus of 98% 1.

Overall, the treatment of inflammatory breast cancer requires a multidisciplinary approach, and the optimum approach is chemotherapy, modified radical mastectomy, and radiotherapy.

From the Research

Optimum Approach to Inflammatory Breast Carcinoma

The optimum approach to inflammatory breast carcinoma involves a combination of treatments. The key aspects of this approach are:

• Chemotherapy: used as an initial treatment to reduce the size of the tumor 2, 3, 4, 5
• Surgery: typically a modified radical mastectomy, performed after chemotherapy to remove the tumor 2, 3, 4, 5
• Radiotherapy: used after surgery to eliminate any remaining cancer cells 2, 3, 4, 5

Treatment Options

The treatment options for inflammatory breast carcinoma are:

• Chemotherapy alone: not recommended as a single-modality treatment 2
• Surgery alone: not recommended as a single-modality treatment 2
• Radiotherapy alone: not recommended as a single-modality treatment 2
• Combination of chemotherapy, surgery, and radiotherapy: recommended as the standard of care for inflammatory breast carcinoma 2, 3, 4, 5

Benefits of Combined-Modality Treatment

The benefits of combined-modality treatment for inflammatory breast carcinoma include:

• Improved disease-free survival rates: 28% of patients remained free of disease beyond 15 years 2
• Improved overall survival rates: compared to single-modality treatments 2
• Reduced risk of local recurrence: compared to single-modality treatments 2, 5

Considerations for Reconstruction

Considerations for reconstruction in inflammatory breast carcinoma include:

• Immediate reconstruction: may be associated with increased complications, but is not associated with decreased survival or increased recurrence in selected patients 6
• Delayed reconstruction: may be a better option for some patients, depending on individual circumstances 6