Is MRM and High Dose Radiation needed

Inflammatory Breast Cancer
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camsdh
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Is MRM and High Dose Radiation needed

Postby camsdh » 21pm28America/New_York()

One of the questions that is ask...If after neo-adjuvant chemo the breast is back to normal and the scans are all clean....Do I really need a MRM and Radiation...


Locoregional Treatment Outcomes After Multimodality
Management of Inflammatory Breast Cancer[/size]

Ian J. Bristol, M.D., Wendy A. Woodward, M.D., Ph.D., Eric A. Strom, M.D.,
Massimo Cristofanilli, M.D., Delora Domain, B.S., S. Eva Singletary, M.D.,
George H. Perkins, M.D., Julia L. Oh, M.D., Tse-Kuan Yu, M.D., Ph.D.,
Welela Terrefe, M.D., Aysegul A. Sahin, M.D., Kelly K. Hunt, M.D.,
Gabriel N. Hortobagyi, M.D., Thomas A. Buchholz, M.D.


Purpose

The aims of this study were to determine outcomes for patients with inflammatory breast cancer (IBC) treated with multimodality therapy, to identify factors associated with locoregional recurrence, and to determine which patients may benefit from radiation dose escalation.

Methods and Materials

We retrospectively reviewed 256 consecutive patients with nonmetastatic IBC treated at our institution between 1977 and 2004.

Results

The 192 patients who were able to complete the planned course of chemotherapy, mastectomy, and postmastectomy radiation had significantly better outcomes than the 64 patients who did not. The respective 5-year outcome rates were: locoregional control (84% vs. 51%), distant metastasis–free survival (47% vs. 20%), and overall survival (51% vs. 24%) (p <0.0001 for all comparisons). Univariate factors significantly associated with locoregional control in the patients who completed plan treatment were response to neoadjuvant chemotherapy, surgical margin status, number of involved lymph nodes, and use of taxanes. Increasing the total chest-wall dose of postmastectomy radiation from 60 Gy to 66 Gy significantly improved locoregional control for patients who experienced less than a partial response to chemotherapy, patients with positive, close, or unknown margins, and patients <45 years of age.

Conclusions

Patients with IBC who are able to complete treatment with chemotherapy, mastectomy, and postmastectomy radiation have a high probability of locoregional control. Escalation of postmastectomy radiation dose to 66 Gy appears to benefit patients with disease that responds poorly to chemotherapy, those with positive, close, or unknown margin status, and those <45 years of age.
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NoBlahMa
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Posts: 6919
Joined: 07pm31America/New_York()
Diagnosed on: Nov 5th, 2004
Diagnosed With: ILC
Mets: None
Cancer Stage: IIIC
Node Status: 9/26
Tumor Size: >8cm
Tumor Grade: Unknown
Receptor Status: er/pr+ her2-
Location: America's Heartland

Re: Is MRM and High Dose Radiation needed

Postby NoBlahMa » 23pm28America/New_York()

For me, a mastectomy and rads was a given. Even though the mass in my breast shrunk from 8cm to <1cm, the type Of bc I had was very diffuse. I chose to have a bilateral mast for the simple reason that imaging tools FAILED me. I wanted the breast cancer GONE!
Stay close to anything that makes you glad you're alive-14th C poet, Hafez
debralynb
Posts: 25
Joined: 27pm28America/New_York()
Diagnosed on: 1-18-2008
Diagnosed With: IBC
Mets: None
Cancer Stage: 3b
Node Status: 2/14
Tumor Grade: Unknown
Receptor Status: Her2/Neu +
Location: Knoxville, TN

Re: Is MRM and High Dose Radiation needed

Postby debralynb » 27pm28America/New_York()

I had both Mastectomy and Rads. Even though an MRI showed that there was no evidence of cancer (thanks to chemo) the BS used the original MRI to determine where she would cut. I only had Left MRM at the time but I have decided to go ahead and have the other one removed at the time of recon. Just for my peace of mind.

Hugs,
Debra
lexi
Posts: 17
Joined: 27am28America/New_York()

Re: Is MRM and High Dose Radiation needed

Postby lexi » 04pm31America/New_York()

In my case because I had spread to my skin as well as 5 pos lymph nodes, the radiation was a given. 30 txs with a bolus used every other tx. The bolus was used to intensify the rads on my skin.

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