Inflammatory Breast Cancer TreatmentThermoradiotherapy Treatment For Localized Inflammatory Breast Cancer
James I. Bicher, M.D., Ralph S. Wolfstein, M.D., Tressia Keen, M.N., Sylvia Carter, Ph.
D.
Valley Cancer Institute, Los Angeles, California
INTRODUCTION
Inflammatory breast cancer is more aggressive than other types of
breast cancer ; indeed, it is one of the most aggressive of all neoplasms.
The best treatment for primary inflammatory breast cancer is
multimodality, as described in several reports in the medical literature. These reports
are quite consistent, with no recurrence in about a third of patients following
chemotherapy, radiotherapy and mastectomy. Inflammatory chest wall recurrence of breast
cancer is an even more devastating problem with essentially no possibility of control
using chemotherapy and/or radiotherapy. This problem occurs about 20-30% of treated
patients, within 24 months of the initial treatment.
We report on the 12 patients with inflammatory breast cancer, either
with extensive primary or recurrent disease, treated over the past 15 years at Valley
Cancer Institute using thermoradiotherapy. All of these patients had erythema and
extensive chest wall disease upon presentation.
MATERIALS AND METHODS
Radiotherapy was delivered by linear accelerator,
using bolused medial and lateral tangential fields. Several patients required additional
fields for disease extending around to the back. A total 2-4 Gy in daily fractions of
80-150 cGy was delivered depending on previous radiation dose and time since previous
radiotherapy. One patient received a full course of 5.6Gy.
Hyperthermia was given within one hour of each
radiation treatment. patients required at least two hyperthermia fields, usually three or
four, with two fields treated daily on a rotating schedule. Most fields were treated by
micro-wave (Celsion
Corporation (former Cheung Laboratories) System 100, 915 MHz). In those patients with
massive breast tumor ultrasound was used (Labthermics
Technologies, Sonotherm 1000, 1MHz and 3MHz). Each hyperthermia treatment was of one
hour duration to each field. On average each patient required 3-4 treatment fields to
cover the entire disease area. Each field received 18-25 hyperthermia treatments.
ABSTRACT
Localized inflammatory breast cancer, usually
extending from the affected breast or mastectomy site to the chest wall is a rapidly
lymphatic spreading form for cancer, usually resistant to radiation or chemotherapy, and
prone to rapid dissemination.
This presentation reports on a phase 1 clinical
trial involving 62 fields in 22 patients. Each field received 2000-4000cGy of external
beam bolused radiation combined with 25 or more hyperthermia treatments given within one
hour of the radiation dose.
Response rate was gratifying. Ninety percent (90%)
of the fields responded to the combined treatment, with complete disappearance of the
inflammatory process in 80% of the treated areas. There was only four recurrences in the
areas of complete response, while areas that responded partially showed regrowth within 3
months of treatment. Side effects were minimal, in the form of 6 first degree, superficial
burns. There was no correlation between the response rate and the radiation dose.
These preliminary results show that
thermoradiotherapy should be considered as a treatment modality for inflammatory breast
cancer.
ResultsAlternative cancer treatment, alternative breast cancer treatment,
alternative prostate cancer treatment.