Excellent locoregional control in inflammatory breast cancer with a personalized radiation therapy approach Journal Article

Authors: Stecklein, S. R.; Rosso, K. J.; Nuanjing, J.; Tadros, A. B.; Weiss, A.; DeSnyder, S. M.; Kuerer, H. M.; Teshome, M.; Buchholz, T. A.; Stauder, M. C.; Ueno, N. T.; Lucci, A.; Woodward, W. A.
Article Title: Excellent locoregional control in inflammatory breast cancer with a personalized radiation therapy approach
Abstract: Purpose: Inflammatory breast cancer (IBC) has been characterized by high locoregional recurrence (LRR) rates even after trimodality therapy. We recently reported excellent locoregional control among patients treated since formal dedication of an IBC-specific clinic and research program in 2006. Institutionally, a standard twice-daily (BID) dose escalation regimen for all patients with IBC was de-escalated in select cases in 2006 after review demonstrated that young age, incomplete response to neoadjuvant therapy, and positive margins identified subsets with maximal benefit from dose escalation. We report local control and toxicity rates specific to BID versus once-daily (QD) radiation therapy approaches. Methods and Materials: From a prospectively collected database, we identified 103 patients with nonmetastatic IBC who received trimodality therapy at our institution from 2007 to 2015. Descriptive statistics were used to describe the study cohort and compare retrospectively extracted rates of radiation therapy–associated toxicity. The actuarial rate of LRR-free survival was analyzed using the Kaplan-Meier method. Results: The median follow-up is 3.6 years. Thirty-nine patients (37.9%) received postmastectomy radiation therapy (PMRT) to the chest wall and undissected regional lymphatics in QD fractions (median dose, 50.0 Gy in 25 fractions [fx]; median boost dose, 10.0 Gy in 5 fx) and 64 patients (62.1%) received BID PMRT (median dose, 51.0 Gy in 34 fx; median boost dose, 15.0 Gy in 10 fx). Crude rates of toxicity were not different between patients treated with QD or BID PMRT. Two BID patients (3.1%) and no QD patients (0.0%) experienced LRR (P = .53). The 3- and 5-year LRR-free survival were 95.1% and 100.0% for BID and QD patients, respectively (P = .25). Conclusions: Tailoring radiation therapy to clinical risk factors was associated with excellent locoregional control. De-escalation of PMRT from BID to QD was not clearly associated with reduced toxicity compared with BID, although retrospective data collection may limit this comparison. © 2019 American Society for Radiation Oncology
Keywords: adult; cancer survival; controlled study; human tissue; aged; middle aged; young adult; major clinical study; overall survival; doxorubicin; disease classification; drug efficacy; drug safety; paclitaxel; cancer adjuvant therapy; cancer radiotherapy; radiation dose; cancer staging; lymph node dissection; carboplatin; infection; cohort analysis; cyclophosphamide; retrospective study; pneumonia; lymphedema; fibrosis; disease severity; dosimetry; partial mastectomy; trastuzumab; lapatinib; health care planning; radiation dermatitis; pertuzumab; personalized medicine; inflammatory breast cancer; local recurrence free survival; human; female; priority journal; article; supraclavicular lymph node
Journal Title: Practical Radiation Oncology
Volume: 9
Issue: 6
ISSN: 1879-8500
Publisher: Elsevier Inc.  
Date Published: 2019-11-01
Start Page: 402
End Page: 409
Language: English
DOI: 10.1016/j.prro.2019.05.011
PUBMED: 31132433
PROVIDER: scopus
Notes: Article -- Source: Scopus
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  1. Audree Blythe Tadros
    11 Tadros