Irradiation in Inflammatory Breast Cancer

  • Irradiation is an integral part of the tri-modality treatment of inflammatory breast cancer
  • Rarely:
    • Radiation may be administered preoperatively:
      • Particularly in the context of a suboptimal response to neoadjuvant systemic therapy or progressive disease
  • Following a mastectomy:
    • Postmastectomy irradiation is routinely given
    • Data from British Columbia:
      • Have demonstrated mastectomy with modern chemotherapy and radiation techniques:
        • Is associated with improved locoregional control
  • Radiotherapy comprises:
    • Whole breast with comprehensive nodal irradiation:
      • In the setting of preoperative treatment
    • Chest wall with comprehensive nodal irradiation:
      • Following a mastectomy
  • Most series report inclusion of the internal mammary lymph node chain in radiation portals:
    • Even if clinically negative
  • For left-sided treatment:
    • Modern techniques, including:
      • Intensity-modulated radiation therapy:
        • May be employed to avoid dose to the heart and lungs while appropriately covering the regional lymph nodes
  • References:
    • Panades M, Olivotto IA, Speers CH, et al. Evolving treatment strategies for inflammatory breast cancer: a population-based survival analysis. J Clin Oncol. 2005;23:1941-1950.
    • Scotti V, Desideri I, Meattini I, et al. Management of inflammatory breast cancer: focus on radiotherapy with an evidence-based approach. Cancer Treat Rev. 2012;39:119-124.
    • Ueno NT, Buzdar AU, Singletary SE, et al. Combined-modality treatment of inflammatory breast carcinoma: twenty years of experience at M.D. Anderson Cancer Center. Cancer Chemother Pharmacol. 1997;40:321-329.
    • Yim J, Suttie C, Bromley R, Morgia M, Lamoury G. Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index. J Med Radiat Sci. 2015;62:184-191.

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