Resume Objectif de l'etude Fondes sur des resultats encourageants de l'alternance de radiotherapie et de chimiotherapie dans les cancers du sein inflammatoires, nous avons teste la faisabilite d'un schema alternant une radiotherapie hyperfractionnee acceleree et une chimiotherapie afin d'augmenter le taux de controle locoregional. Patientes et methodes De mai 1991 a mai 1995, 54 patientes atteintes d'un cancer du sein inflammatoire non metastatique ont ete traitees selon un schema therapeutique alternant huit cycles de chimiotherapie et deux series de radiotherapie hyperfractionnee acceleree delivrant une dose totale de 66 Gy. Apres trois cycles de chimiotherapie de type AVCMF (adriamycine, vincristine, cyclophosphamide, methotrexate, 5-fluoro-uracile), les patientes ont recu une premiere serie de radiotherapie hyperfractionnee acceleree de 45 Gy en trois semaines dans le sein et les ganglions axillaires, sus-claviculaires et mammaires internes. Les deux seances quotidiennes de 1,5 Gy etaient separees d'un intervalle de six heures au moins. La seconde serie consistait en un complement d'irradiation de 21 Gy en 14 fractions et dix jours alternant avec une chimiotherapie, de type FAC (5-fluoro-uracile, adriamycine et cyclophosphamide) ou FEC (5-fluoro-uracile, epiadriamycine et cyclophosphamide), en tout cinq cycles espaces de trois semaines. Toutes les patientes ont eu un traitement hormonal. Resultats Parmi les 53 patientes evaluees, 44 (83 %) etaient en situation de remission clinique complete, sept (13%) de reponse partielle et deux (4%) de progression tumorale. La duree mediane de la surveillance etait de 46 mois (quatre a 81) et 18 des 51 tumeurs controlees ont fait une rechute locale et/ou regionale (35 %). Huit patientes ont du avoir une mastectomie (15%). Au total, 26 patientes (50 %) ont souffert d'une dissemination metastatique. Les taux de survie globale a trois et cinq ans etaient respectivement de 66 et 45 %, et les taux de survie sans recidive de 45 et 36 %. Conclusion L'alternance de radiotherapie hyperfractionnee acceleree et de chimiotherapie a ete bien toleree et a permis un taux de controle local satisfaisant. Le pronostic du cancer du sein inflammatoire reste cependant greve par une forte mortalite secondaire a la dissemination metastatique, ce qui justifie l'etude de nouvelles modalites therapeutiques.

Radiothérapie hyperfractionnée accélérée alternée avec une chimiothérapie dans le cancer du sein inflammatoire non métastatique

Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Currently, patients who respond to neoadjuvant chemotherapy (NAC) are treated with mastectomy and axillary lymph node dissection. This study aimed to synthesize real-world data to evaluate the feasibility of breast-conserving therapy (BCT), sentinel lymph node (SLN), and sentinel lymph node biopsy (SLNB) for patients with IBC who respond to NAC.PubMed, Embase, and Cochrane Library databases were searched for relevant articles. Clinical studies that compared mastectomy with BCT for IBC treatment were reviewed. The primary outcomes were local recurrence rate and 5-y survival rate in patients with IBC who responded to NAC. Furthermore, the SLN detection rate and false-negative rate (FNR) for SLNB were also evaluated.In the final analysis, 17 studies were included. The pooled estimates of the local recurrence rate for mastectomy and no surgical intervention were 18.6% and 15.9%, respectively (P = 0.956). Five-y survival was similar for mastectomy, partial mastectomy, and no surgical intervention (45.8%, 57.1%, and 39.4%, respectively). The pooled estimates of the SLN detection rate and FNR for SLNB were 81.9% and 21.8%, respectively.Among patients with IBC who respond to NAC, the local recurrence and 5-y survival rates in those undergoing BCT are noninferior to the rates in those undergoing mastectomy; therefore, BCT could be a feasible option for surgical management. However, a poor SLN detection rate and a high FNR were found in patients undergoing SLNB. Further large-scale clinical studies are required to confirm our findings. 

Outcomes of Breast-Conserving Therapy in Patients With Inflammatory Breast Cancer: A Meta-Analysis.

Inflammatory breast cancer (IBC) is an aggressive form of breast cancer characterized by rapid progression and early metastatic dissemination. The purpose of this study was to assess contemporary rates of local regional recurrence (LRR) in the era of trimodality therapy for nonmetastatic IBC and identify risk factors leading to local failure. A total of 114 patients with nonmetastatic IBC receiving trimodality therapy (neoadjuvant chemotherapy, surgery, and radiation therapy) were identified from a prospectively collected database from 2007 to 2015 and outcomes analyzed. Median age at diagnosis was 52 years, and the median follow-up was 3.6 years. Sixty-three (55%) patients presented with N2 IBC, and 52 patients (45%) presented with N3 IBC. Local regional recurrence was observed during follow-up for four patients; 25 died, and 85 were censored at last follow-up. Surgical margins were negative in 99% of patients (n = 113). The 2-year probability of LRR was 3.19% (95% confidence interval 1.03–9.90%). Five-year overall survival for this cohort was 69.14%. Improvement in disease-free survival was seen among patients with HER2+ subtype, clinical stage IIIB, complete or partial radiologic response to neoadjuvant therapy, pathologic complete response, and lower nodal burden on presentation. Locoregional recurrences were rare at a median of 3.6 years follow-up in a contemporary cohort of IBC patients treated with trimodality therapy. Although longer follow-up is needed, aggressive surgical resection to negative margins in the frame of trimodality therapy with curative intent can lead to LRR rates that mirror non-IBC rates.

Improved Locoregional Control in a Contemporary Cohort of Nonmetastatic Inflammatory Breast Cancer Patients Undergoing Surgery.

Combined chemotherapy, radiotherapy and surgery in inflammatory breast carcinoma

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Combined chemotherapy, radiotherapy and surgery in inflammatory breast carcinoma