Nicaise Benjamin, Loap Pierre, Loirat Delphine, Laki Fatima, Pierga Jean-Yves, Fourquet Alain, Kirova Youlia
Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
Faculty of Medicine, Sorbonne Université, 75006 Paris, France.
Cancers (Basel). 2021 Dec 27;14(1):107. doi: 10.3390/cancers14010107.
(1) Background: Inflammatory breast cancers (IBC) are characterized by a poor prognosis. This retrospective study aims to describe the clinical outcomes of non-metastatic IBC patients treated with a multidisciplinary approach with neo-adjuvant chemotherapy, surgery, and radiotherapy. (2) Methods: This single-center retrospective study included all women patients diagnosed with non-metastatic IBC between January 2010 and January 2018 at the Institut Curie (Paris, France) and treated with neoadjuvant chemotherapy, surgery, and radiotherapy. Overall survival (OS), disease-free survival (DFS), and locoregional free survival (LRRFS) were calculated from the time of diagnosis. Prognostic factors for patient survival were analyzed based on univariate and multivariate regressions. (3) Results: We identified 113 patients with a median age of 51 years. 79.7% had node-positive tumors; triple-negative breast cancers (TNBC) represented 34.6% of the cases. A large majority of patients (91.2%) received adjuvant post-mastectomy while ten patients (8.8%) received preoperative radiotherapy. Non-pathological complete response (non-pCR) was observed in 67.3% of patients. Radiotherapy delivered a median dose of 50 Gy to the breast or the chest wall in 25 fractions. With a median follow-up of 54 months, 5-year OS, DFS and LRRFS were 78% (CI: 70.1-86.8%), 68.1% (59.6-77.7%), and 85.2% (78.4-92.7%), respectively. In multivariate analysis, non-pCR was an adverse prognosis factor for OS, DFS, and LRRFS; pre-operative radiotherapy was an adverse prognosis factor for OS and DFS. Radiation-related adverse events were limited to acute skin toxicity (22% of Grade 2 and 2% of grade 3 dermatitis); no late radiation-induced toxicity was reported. (4) Conclusions: High locoregional control could be achieved with multidisciplinary management of non-metastatic IBC, suggesting the anti-tumor efficacy of radiotherapy in this rare but pejorative clinicopathological presentation. While comparing favorably with historical cohorts, OS and DFS could be potentially improved in the future with the use of new systemic treatments, such as PARP-inhibitors or immunotherapy.
(1) 背景：炎性乳腺癌（IBC）的预后较差。本回顾性研究旨在描述采用新辅助化疗、手术和放疗的多学科方法治疗的非转移性IBC患者的临床结局。(2) 方法：这项单中心回顾性研究纳入了2010年1月至2018年1月期间在居里研究所（法国巴黎）被诊断为非转移性IBC并接受新辅助化疗、手术和放疗的所有女性患者。从诊断时间开始计算总生存期（OS）、无病生存期（DFS）和局部区域无复发生存期（LRRFS）。基于单变量和多变量回归分析患者生存的预后因素。(3) 结果：我们确定了113例患者，中位年龄为51岁。79.7%的患者肿瘤有淋巴结转移；三阴性乳腺癌（TNBC）占病例的34.6%。绝大多数患者（91.2%）接受了乳房切除术后辅助治疗，而10例患者（8.8%）接受了术前放疗。67.3%的患者观察到非病理完全缓解（non-pCR）。放疗对乳房或胸壁给予的中位剂量为50 Gy，分25次进行。中位随访54个月，5年OS、DFS和LRRFS分别为78%（CI：70.1 - 86.8%）、68.1%（59.6 - 77.7%）和85.2%（78.4 - 92.7%）。在多变量分析中，non-pCR是OS、DFS和LRRFS的不良预后因素；术前放疗是OS和DFS的不良预后因素。放疗相关不良事件仅限于急性皮肤毒性（22%为2级皮炎，2%为3级皮炎）；未报告晚期放射性毒性。(4) 结论：通过对非转移性IBC的多学科管理可实现较高的局部区域控制率，这表明放疗在这种罕见但预后较差的临床病理表现中具有抗肿瘤疗效。虽然与历史队列相比情况较好，但未来使用新的全身治疗方法，如PARP抑制剂或免疫疗法，OS和DFS可能会得到进一步改善。
