Once-daily postmastectomy radiation therapy confers excellent locoregional control for inflammatory breast cancer Journal Article
| Authors: | Pawloski, K. R.; Xu, A.; Diskin, B.; Sevilimedu, V.; Bromberg, J.; Malhotra, S.; Khan, A. J.; Morrow, M.; Tadros, A. B. |
| Article Title: | Once-daily postmastectomy radiation therapy confers excellent locoregional control for inflammatory breast cancer |
| Abstract: | Purpose: For patients with cT4dM0 inflammatory breast cancer (IBC), improved locoregional control has been reported following modern trimodality therapy that includes hyperfractionated/twice-daily postmastectomy radiation therapy (PMRT). We evaluated survival outcomes in a contemporary cohort of patients with IBC routinely treated with once-daily PMRT. Methods and Materials: We retrospectively identified 213 patients with stage III IBC treated with neoadjuvant systemic therapy, modified radical mastectomy, and PMRT from January 2006 to December 2022 at a single institution. Routinely, PMRT included 50 Gy in 18 to 25 daily fractions to the chest wall and regional nodes with a 0.5 to 1.0 cm skin bolus. We calculated the crude rate of isolated locoregional recurrence (LRR) and estimated disease-free survival (DFS) rates using Kaplan-Meier survival curves and a Cox proportional hazard regression model. Results: Median follow-up was 3.5 years (IQR, 1.8-6.3 years). Isolated LRR was observed in 1.8% (4/213) of patients at a median of 10.6 months (IQR, 8.8-18.4 months). LRR with or without a distant failure occurred in 22 patients (10.3%). All LRRs were observed in patients who did not achieve pathologic complete response (pCR) (n = 148). Distant metastasis occurred in 32% (69/213) of patients, and 57 deaths were recorded. On multivariable analysis, triple-negative subtype (hazard ratio [HR], 3.16; 95% CI, 1.56-6.41; P = .001), lobular histology (HR, 2.45; 95% CI, 1.10-5.45; P = .027), and nodal pCR (HR, 0.27; 95% CI, 0.15-0.49; P < .001) were associated with DFS rates. Subgroup analysis demonstrated no difference in DFS rates between biologic subtypes in patients with pCR (P = .29). Conclusions: Once-daily PMRT confers excellent locoregional control in patients with IBC, as evidenced by low rates of isolated LRR at 3.5 years of follow-up. The worse overall LRR and DFS rates observed in patients with triple-negative subtype and residual nodal disease indicate a need to consider escalating local therapy with a boost while also emphasizing the necessity for novel systemic therapies for IBC. © 2025 Elsevier Inc. |
| Keywords: | survival rate; systemic therapy; disease free survival; follow up; radiotherapy; lung cancer; patient monitoring; pathology; oncology; histology; hazard ratio; regression analysis; locoregional control; diseases; hazards; complete response; locoregional recurrence; postmastectomy radiation therapies; inflammatory breast cancers |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Publication status: | Online ahead of print |
| Date Published: | 2025-06-12 |
| Online Publication Date: | 2025-06-12 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2025.05.075 |
| PUBMED: | 40516632 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Audree B. Tadros -- Source: Scopus |
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