Primary inflammatory carcinoma of the female breast: staging and treatment possibilities.

Primary inflammatory carcinoma of the breast, which is considered inoperable, has a prognosis that has led to therapeutic nihilism. Treatment of 81 such patients between 1954 and 1981 is reported here. When first seen, 28 patients had clinically localized disease (median survival 48 months) and 53 had regional disease (median survival 26 months). Thus there is a significant difference in survival rates (p less than 0.05). Of the 81 patients, 32 were treated primarily with radiotherapy (Baclesse), 37 were treated with chemotherapy then radiotherapy followed by chemotherapy maintenance, and 12 were treated with chemotherapy followed by extended simple mastectomy and chemotherapy maintenance. For the three treatment protocols, survival times for patients with localized disease were 50, 45, and 50 months and for patients with regional disease survival times were 13, 32, and 47 months, which demonstrates that patients with metastatic disease benefit from chemotherapy and perhaps in selected cases surgery. Thirty-five percent of the 28 patients with localized disease and 20% of the 53 patients with regional disease survived 5 years, for an overall 5-year survival rate of 26%. Of the 13% of patients who survived 10 years, 18% had localized disease and 10% had regional disease. Both clinical staging and treatment factors are important in the prognosis for patients with primary inflammatory carcinoma of the female breast.