[Inflammatory cancer of the breast. Therapy and follow-up]

Abstract

Inflammatory carcinoma has the highest mortality rate amongst the locally progressed cancers of the female breast. To define it, clinical, pathological and biological criteria have to be considered. The crucial finding is tumour-cell embolism in the subdermal lymphatics of the affected breast. 30 patients with inflammatory breast cancer were treated with three different concepts of therapy. In the first group, initial surgery (mastectomy with axillary dissection) was followed first by 6 cycles of chemotherapy, then by radiation of the thoracic wall, axilla and supraclavicular lymph nodes. The second concept included primary chemotherapy (6 cycles) with mastectomy/axillary dissection after the second or third cycles. In the third group, primary radiation of breast and axilla was performed, followed by 6 cycles of chemotherapy. From all three groups, 9 patients showed receptor-positive tumours; additional tamoxifen therapy (if postmenopausal) or GNRH-analogues (if premenopausal) were given. None of the three therapy managements could improve the average time of survival. Only the patients with hormonal therapy showed a better prognosis, which might well have been the result of a higher differentiation of the tumour. The study proves, that our efforts in therapy have so far been insufficient. Mastectomy, in particular as a psychically traumatizing procedure, fails to improve the patient's prognosis. It might regain its importance, when new, satisfactory methods of therapy of the systemic disease "inflammatory breast cancer" have been found. It is still uncertain, whether better prognosis can be achieved by a treatment with GNRH-analogues.