Once-Daily Radiation Therapy for Inflammatory Breast Cancer

Journal Article · Fri Aug 01 04:00:00 EDT 2014 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2014.01.054· OSTI ID:22420386

Brown, Lindsay ^[1]; Harmsen, William ^[2]; Blanchard, Miran ^[1]; Goetz, Matthew ^[3]; Jakub, James ^[4]; Mutter, Robert; Petersen, Ivy; Rooney, Jessica ^[1]; Stauder, Michael ^[5]; Yan, Elizabeth ^[1]; Laack, Nadia ^[1]

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1. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)
2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota (United States)
3. Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota (United States)
4. Department of Surgery, Mayo Clinic, Rochester, Minnesota (United States)
5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

Purpose: Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer variant treated with multimodality therapy. A variety of approaches intended to escalate the intensity and efficacy of radiation therapy have been reported, including twice-daily radiation therapy, dose escalation, and aggressive use of bolus. Herein, we examine our outcomes for patients treated with once-daily radiation therapy with aggressive bolus utilization, focusing on treatment technique. Methods and Materials: A retrospective review of patients with nonmetastatic IBC treated from January 1, 2000, through December 31, 2010, was performed. Locoregional control (LRC), disease-free survival (DFS), overall survival (OS) and predictors thereof were assessed. Results: Fifty-two women with IBC were identified, 49 (94%) of whom were treated with neoadjuvant chemotherapy. All underwent mastectomy followed by adjuvant radiation therapy. Radiation was delivered in once-daily fractions of 1.8 to 2.25 Gy (median, 2 Gy). Patients were typically treated with daily 1-cm bolus throughout treatment, and 33 (63%) received a subsequent boost to the mastectomy scar. Five-year Kaplan Meier survival estimates for LRC, DFS, and OS were 81%, 56%, and 64%, respectively. Locoregional recurrence was associated with poorer OS (P<.001; hazard ratio [HR], 4.1). Extracapsular extension was associated with worse LRC (P=.02), DFS (P=.007), and OS (P=.002). Age greater than 50 years was associated with better DFS (P=.03). Pathologic complete response was associated with a trend toward improved LRC (P=.06). Conclusions: Once-daily radiation therapy with aggressive use of bolus for IBC results in outcomes consistent with previous reports using various intensified radiation therapy regimens. LRC remains a challenge despite modern systemic therapy. Extracapsular extension, age ≤50 years, and lack of complete response to chemotherapy appear to be associated with worse outcomes. Novel strategies are needed in IBC, particularly among these subsets of patients.

• OSTI ID: 22420386
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 89; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
INFLAMMATION
MAMMARY GLANDS
NEOPLASMS
PATIENTS
RADIATION DOSES
RADIOTHERAPY
REVIEWS
WOMEN