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.

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO