Institut Curie, Department of Radiation Oncology, Paris, France.
Institut Curie, Department of Surgery, Paris, France.
Strahlenther Onkol. 2023 Jan;199(1):30-37. doi: 10.1007/s00066-022-01960-z. Epub 2022 Jun 1.
Chemorefractory nonmetastatic inflammatory breast cancer (IBC) which progresses under neoadjuvant chemotherapy poses specific therapeutic challenges: either pursuing a curative-intent treatment with a salvage combination of radiotherapy and surgery or switching to second-line systemic treatments despite the absence of metastasis. Due to the rarity of this situation, no specific management guidelines exist and the outcomes of these patients remain uncertain. In this retrospective observational study, we aimed to report the clinical outcomes of patients treated in a curative intent for chemorefractory nonmetastatic IBC, with a multimodal salvage treatment combining radiotherapy and surgery.
This single-center retrospective observational study included all chemorefractory nonmetastatic IBC treated at the Institut Curie (Paris, France). Overall survival (OS), disease-free survival (DFS), and locoregional relapse-free survival (LRRFS) were calculated from the time of diagnosis and from the time of neoadjuvant chemotherapy interruption.
Between January 2010 and January 2018, 7 patients presented with chemorefractory nonmetastatic IBC with a progressive disease during neoadjuvant chemotherapy. Overall, chemorefractory IBC patients were young (median age of 50 years), had a good performance status, and usually presented with node-positive tumors characterized by a combination of adverse histological factors such as triple-negative breast cancer (TNBC), grade III, and high proliferation index. From the date of pathological diagnosis, 1‑year OS, DFS, and LRRFS were 64.3%, 53.6%, and 71.4%, respectively. From the date of neoadjuvant chemotherapy interruption, 1‑year OS, DFS, and LRRFS were 47.6%, 19.0%, and 45.7%, respectively, and median OS, DFS, and LRRFS were 8.3, 5.0, and 5.0 months, respectively.
The prognosis of chemorefractory nonmetastatic IBC treated with a multimodal approach combining surgery and radiotherapy is particularly reserved, despite the curative intent of the salvage treatment and the lack of distant metastasis at the time of treatment. Optimal treatment modalities are still to be defined in this rare but critical presentation of IBC.
新辅助化疗后进展的化学难治性非转移性炎性乳腺癌（IBC）带来了特殊的治疗挑战：要么采用挽救性联合放疗和手术的根治性治疗，要么在没有转移的情况下改用二线全身治疗。由于这种情况很少见，因此没有具体的管理指南，这些患者的结局仍不确定。在这项回顾性观察研究中，我们旨在报告在根治性意向下接受治疗的化学难治性非转移性 IBC 患者的临床结局，采用联合放疗和手术的多模式挽救性治疗。
这项单中心回顾性观察性研究纳入了所有在巴黎居里研究所（Institut Curie）接受治疗的化学难治性非转移性 IBC 患者。从诊断时和新辅助化疗中断时开始计算总生存期（OS）、无病生存期（DFS）和局部区域无复发生存期（LRRFS）。
2010 年 1 月至 2018 年 1 月期间，有 7 名患者在新辅助化疗期间出现进展性疾病，诊断为化学难治性非转移性 IBC。总体而言，化学难治性 IBC 患者较年轻（中位年龄为 50 岁），体能状态良好，且通常表现为淋巴结阳性肿瘤，具有三阴性乳腺癌（TNBC）、III 级和高增殖指数等不良组织学因素的组合。从病理诊断时起，1 年 OS、DFS 和 LRRFS 分别为 64.3%、53.6%和 71.4%。从新辅助化疗中断时起，1 年 OS、DFS 和 LRRFS 分别为 47.6%、19.0%和 45.7%，中位 OS、DFS 和 LRRFS 分别为 8.3、5.0 和 5.0 个月。
尽管挽救性治疗具有根治性意图，且在治疗时无远处转移，但采用手术和放疗相结合的多模式方法治疗化学难治性非转移性 IBC 的预后尤其不佳。在这种罕见但关键的 IBC 表现中，仍需要确定最佳的治疗方式。
