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Pract Radiat Oncol. 2019 May 24. pii: S1879-8500(19)30142-0. doi: 10.1016/j.prro.2019.05.011. [Epub ahead of print]

Excellent Locoregional Control in Inflammatory Breast Cancer With a Personalized Radiation Therapy Approach.

Author information

1
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Banner MD Anderson Cancer Center, Gilbert, Arizona.
3
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
4
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Surgical Oncology, Brigham and Women's Faulkner Breast Center and Dana-Farber Cancer Institute, Boston, Massachusetts.
5
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
6
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Scripps MD Anderson Cancer Center, La Jolla, California.
7
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas.
8
Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas.
9
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: wwoodward@mdanderson.org.

Abstract

PURPOSE:

Inflammatory breast cancer (IBC) has been characterized by high locoregional recurrence (LRR) rates even after trimodality therapy. We recently reported excellent locoregional control among patients treated since formal dedication of an IBC-specific clinic and research program in 2006. Institutionally, a standard twice-daily (BID) dose escalation regimen for all patients with IBC was de-escalated in select cases in 2006 after review demonstrated that young age, incomplete response to neoadjuvant therapy, and positive margins identified subsets with maximal benefit from dose escalation. We report local control and toxicity rates specific to BID versus once-daily (QD) radiation therapy approaches.

METHODS AND MATERIALS:

From a prospectively collected database, we identified 103 patients with nonmetastatic IBC who received trimodality therapy at our institution from 2007 to 2015. Descriptive statistics were used to describe the study cohort and compare retrospectively extracted rates of radiation therapy-associated toxicity. The actuarial rate of LRR-free survival was analyzed using the Kaplan-Meier method.

RESULTS:

The median follow-up is 3.6 years. Thirty-nine patients (37.9%) received postmastectomy radiation therapy (PMRT) to the chest wall and undissected regional lymphatics in QD fractions (median dose, 50.0 Gy in 25 fractions [fx]; median boost dose, 10.0 Gy in 5 fx) and 64 patients (62.1%) received BID PMRT (median dose, 51.0 Gy in 34 fx; median boost dose, 15.0 Gy in 10 fx). Crude rates of toxicity were not different between patients treated with QD or BID PMRT. Two BID patients (3.1%) and no QD patients (0.0%) experienced LRR (P = .53). The 3- and 5-year LRR-free survival were 95.1% and 100.0% for BID and QD patients, respectively (P = .25).

CONCLUSIONS:

Tailoring radiation therapy to clinical risk factors was associated with excellent locoregional control. De-escalation of PMRT from BID to QD was not clearly associated with reduced toxicity compared with BID, although retrospective data collection may limit this comparison.

PMID:
31132433
DOI:
10.1016/j.prro.2019.05.011

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