Risk factors for locoregional failure in patients with inflammatory breast cancer treated with trimodality therapy

Kunal Saigal, Judith Hurley, Cristiane Takita, Isildinha Reis, Wei Zhao, Steven Rodgers, Jean L. Wright

Research output: Contribution to journalArticle

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Abstract

Purpose To compare patterns of local and regional failure between patients with inflammatory breast cancer (IBC) and non-IBC in patients treated with trimodality therapy. Materials and Methods We reviewed records of 463 patients with stage II/III breast cancer, including IBC, who completed trimodality therapy from January 1999 to December 2009. Results The median follow-up was 46.3 months (range, 4-152 months). Clinical stage was 29.4% (n = 136) II, 56.4% (n = 261) non-IBC III, 14.2% (n = 66) IBC, 30.5% (n = 141) cN0/Nx, and 69.5% (n = 322) N1-N3c. All the patients received neoadjuvant therapy and mastectomy (98%, n = 456 with axillary dissection), and all had postmastectomy radiation therapy to the chest wall with or without supraclavicular nodes (82.5%, n = 382) with or without axilla (6%, n = 28). The median chest wall dose was 60.4 Gy. Patients with IBC presented with larger tumors (P <.001) and exhibited a poorer response to neoadjuvant therapy: after surgery, fewer patients with IBC were ypN0 (P =.003) and more had ≥ 4 positive nodes (P <.001). Four-year cumulative incidence of locoregional recurrence was 5.9%, with 25 locoregional events, 9 of which had a regional component. On multivariate analysis, triple-negative disease (hazard ratio [HR] 7.75, P <.0001) and residual pathologic nodes (HR 7.10, P <.001) were associated with an increased risk of locoregional recurrence, but IBC was not. However, on multivariate analysis, the 4-year cumulative incidence of regional recurrence specifically was significantly higher in IBC (HR 9.87, P =.005). Conclusion In this cohort of patients who completed trimodality therapy, the patients with IBC were more likely to have residual disease in the axilla after neoadjuvant therapy and were at greater risk of regional recurrence. Future study should focus on optimizing regional nodal management in IBC.

Original languageEnglish
Pages (from-to)335-343
Number of pages9
JournalClinical Breast Cancer
Volume13
Issue number5
DOIs
StatePublished - Oct 1 2013

Fingerprint

Inflammatory Breast Neoplasms
Neoadjuvant Therapy
Recurrence
Axilla
Therapeutics
Thoracic Wall
Breast Neoplasms
Multivariate Analysis
Mastectomy
Incidence
Dissection
Radiotherapy

Keywords

  • Breast cancer
  • Inflammatory breast cancer
  • Locoregional recurrence
  • Neoadjuvant chemotherapy
  • Postmastectomy radiation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Risk factors for locoregional failure in patients with inflammatory breast cancer treated with trimodality therapy. / Saigal, Kunal; Hurley, Judith; Takita, Cristiane; Reis, Isildinha; Zhao, Wei; Rodgers, Steven; Wright, Jean L.

In: Clinical Breast Cancer, Vol. 13, No. 5, 01.10.2013, p. 335-343.

Research output: Contribution to journalArticle

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abstract = "Purpose To compare patterns of local and regional failure between patients with inflammatory breast cancer (IBC) and non-IBC in patients treated with trimodality therapy. Materials and Methods We reviewed records of 463 patients with stage II/III breast cancer, including IBC, who completed trimodality therapy from January 1999 to December 2009. Results The median follow-up was 46.3 months (range, 4-152 months). Clinical stage was 29.4{\%} (n = 136) II, 56.4{\%} (n = 261) non-IBC III, 14.2{\%} (n = 66) IBC, 30.5{\%} (n = 141) cN0/Nx, and 69.5{\%} (n = 322) N1-N3c. All the patients received neoadjuvant therapy and mastectomy (98{\%}, n = 456 with axillary dissection), and all had postmastectomy radiation therapy to the chest wall with or without supraclavicular nodes (82.5{\%}, n = 382) with or without axilla (6{\%}, n = 28). The median chest wall dose was 60.4 Gy. Patients with IBC presented with larger tumors (P <.001) and exhibited a poorer response to neoadjuvant therapy: after surgery, fewer patients with IBC were ypN0 (P =.003) and more had ≥ 4 positive nodes (P <.001). Four-year cumulative incidence of locoregional recurrence was 5.9{\%}, with 25 locoregional events, 9 of which had a regional component. On multivariate analysis, triple-negative disease (hazard ratio [HR] 7.75, P <.0001) and residual pathologic nodes (HR 7.10, P <.001) were associated with an increased risk of locoregional recurrence, but IBC was not. However, on multivariate analysis, the 4-year cumulative incidence of regional recurrence specifically was significantly higher in IBC (HR 9.87, P =.005). Conclusion In this cohort of patients who completed trimodality therapy, the patients with IBC were more likely to have residual disease in the axilla after neoadjuvant therapy and were at greater risk of regional recurrence. Future study should focus on optimizing regional nodal management in IBC.",
keywords = "Breast cancer, Inflammatory breast cancer, Locoregional recurrence, Neoadjuvant chemotherapy, Postmastectomy radiation",
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AU - Hurley, Judith

AU - Takita, Cristiane

AU - Reis, Isildinha

AU - Zhao, Wei

AU - Rodgers, Steven

AU - Wright, Jean L.

PY - 2013/10/1

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N2 - Purpose To compare patterns of local and regional failure between patients with inflammatory breast cancer (IBC) and non-IBC in patients treated with trimodality therapy. Materials and Methods We reviewed records of 463 patients with stage II/III breast cancer, including IBC, who completed trimodality therapy from January 1999 to December 2009. Results The median follow-up was 46.3 months (range, 4-152 months). Clinical stage was 29.4% (n = 136) II, 56.4% (n = 261) non-IBC III, 14.2% (n = 66) IBC, 30.5% (n = 141) cN0/Nx, and 69.5% (n = 322) N1-N3c. All the patients received neoadjuvant therapy and mastectomy (98%, n = 456 with axillary dissection), and all had postmastectomy radiation therapy to the chest wall with or without supraclavicular nodes (82.5%, n = 382) with or without axilla (6%, n = 28). The median chest wall dose was 60.4 Gy. Patients with IBC presented with larger tumors (P <.001) and exhibited a poorer response to neoadjuvant therapy: after surgery, fewer patients with IBC were ypN0 (P =.003) and more had ≥ 4 positive nodes (P <.001). Four-year cumulative incidence of locoregional recurrence was 5.9%, with 25 locoregional events, 9 of which had a regional component. On multivariate analysis, triple-negative disease (hazard ratio [HR] 7.75, P <.0001) and residual pathologic nodes (HR 7.10, P <.001) were associated with an increased risk of locoregional recurrence, but IBC was not. However, on multivariate analysis, the 4-year cumulative incidence of regional recurrence specifically was significantly higher in IBC (HR 9.87, P =.005). Conclusion In this cohort of patients who completed trimodality therapy, the patients with IBC were more likely to have residual disease in the axilla after neoadjuvant therapy and were at greater risk of regional recurrence. Future study should focus on optimizing regional nodal management in IBC.

AB - Purpose To compare patterns of local and regional failure between patients with inflammatory breast cancer (IBC) and non-IBC in patients treated with trimodality therapy. Materials and Methods We reviewed records of 463 patients with stage II/III breast cancer, including IBC, who completed trimodality therapy from January 1999 to December 2009. Results The median follow-up was 46.3 months (range, 4-152 months). Clinical stage was 29.4% (n = 136) II, 56.4% (n = 261) non-IBC III, 14.2% (n = 66) IBC, 30.5% (n = 141) cN0/Nx, and 69.5% (n = 322) N1-N3c. All the patients received neoadjuvant therapy and mastectomy (98%, n = 456 with axillary dissection), and all had postmastectomy radiation therapy to the chest wall with or without supraclavicular nodes (82.5%, n = 382) with or without axilla (6%, n = 28). The median chest wall dose was 60.4 Gy. Patients with IBC presented with larger tumors (P <.001) and exhibited a poorer response to neoadjuvant therapy: after surgery, fewer patients with IBC were ypN0 (P =.003) and more had ≥ 4 positive nodes (P <.001). Four-year cumulative incidence of locoregional recurrence was 5.9%, with 25 locoregional events, 9 of which had a regional component. On multivariate analysis, triple-negative disease (hazard ratio [HR] 7.75, P <.0001) and residual pathologic nodes (HR 7.10, P <.001) were associated with an increased risk of locoregional recurrence, but IBC was not. However, on multivariate analysis, the 4-year cumulative incidence of regional recurrence specifically was significantly higher in IBC (HR 9.87, P =.005). Conclusion In this cohort of patients who completed trimodality therapy, the patients with IBC were more likely to have residual disease in the axilla after neoadjuvant therapy and were at greater risk of regional recurrence. Future study should focus on optimizing regional nodal management in IBC.

KW - Breast cancer

KW - Inflammatory breast cancer

KW - Locoregional recurrence

KW - Neoadjuvant chemotherapy

KW - Postmastectomy radiation

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