Macroscopic and microscopic pathology review was used to assess the degree of tumor reduction after preoperative chemotherapy in 90 patients with inflammatory and locally advanced breast cancer. Fifteen (17%) patients had no evident residual macroscopic tumor on gross pathological examination, and 6 of these 15 had no residual tumor on microscopic review either. There was no significant difference in disease-free and overall survival between the six patients with no microscopic disease and the nine patients with only microscopic residual disease but no residual macroscopic tumor. These 15 patients with major reduction after induction chemotherapy had a longer disease-free survival (DFS) (median not reached at 5 yr) than the other 75 patients with lesser degrees of tumor reduction (DFS = 22 mo; P Clinical evaluation of response to chemotherapy was a less accurate predictor of outcome than was the pathological assessment of response. Complete clinical responders had a 4-yr DFS of 55%, whereas patients with non macroscopic residual tumor following preoperative chemotherapy, less than one-half of whom had been judged to be a complete clinical responder, had a median DFS of >60 mo and a 4-yr DFS of 75%. Patients whose mastectomy specimen had no macroscopic residual disease had a 93% 5-yr survival compared to patients with a less marked response to therapy who had a 5-yr survival of 30% ( P Achievement of a mastectomy specimen free of residual macroscopic tumor after preoperative chemotherapy is an excellent prognostic factor for a prolonged DFS and survival. This information should be considered in the selection of postoperative systemic therapy.

https://cancerres.aacrjournals.org/content/canres/46/5/2578.full.pdf

Pathological Assessment of Response to Induction Chemotherapy in Breast Cancer

PURPOSEThe natural history of inflammatory breast cancer and the recent advances in its management were reviewed.DESIGNThe English medical literature from 1924 to 1990 was reviewed using the Cancerline and Medline retrieval systems, and through a manual review of bibliographies of identified articles.RESULTSThe majority of patients with inflammatory breast cancer treated only with local therapies died 18 to 24 months after diagnosis. A combined modality approach with chemotherapy, surgery, and radiation therapy has improved disease-free and overall survival rates for inflammatory breast cancer. Approximately 35% to 55% of patients treated with combined modality regimens remain disease-free and alive at 5 years.CONCLUSIONInduction combination chemotherapy administered with radiation therapy, mastectomy, both, or with additional chemotherapy favorably alters the natural history of inflammatory breast cancer. New drug combinations and high-dose chemotherapy with autologous bone marrow support are being evalu...

Inflammatory breast cancer: a review.

Locally advanced breast cancer remains a clinical challenge as the majority of patients with this diagnosis develop distant metastases despite appropriate therapy. Patients with locally advanced disease encompass a wide range of clinical scenarios including advanced primary tumors (stage T4), advanced nodal disease (fixed axillary nodes or involvement of ipsilateral supraclavicular, infraclavicular, or internal mammary nodes), and inflammatory carcinomas. The prognoses of women with locally advanced breast tumors are also heterogeneous and depend on tumor size, extent of lymph node involvement, and the presence or absence of inflammatory carcinoma. Women with locally advanced disease require multimodal therapy, and coordinated treatment planning among the medical oncologist, surgical oncologist, and radiation oncologist is necessary to optimize patient care. In this article, the epidemiology, evaluation, prognostic factors, and treatment for locally advanced breast cancer are discussed. Inflammatory cancer is also reviewed, but is considered separately due to its distinct biology and clinical behavior.

Update on locally advanced breast cancer.

C-erbB-2 and epidermal growth factor receptor (EGFR) genes were independently shown to be associated with breast cancer progression. In this report, we have analyzed the structure and expression of these 2 genes in the same tumor specimens of a large series of breast cancers. Two clinical types of tumor were studied: inflammatory (IBC) and non-inflammatory breast cancers (NBC) obtained from 221 untreated patients at different clinical stages. Amplification and over-expression of the c-erbB-2 proto-oncogene were observed in 27% and 47% of tumors, respectively, and were strongly associated with breast cancers of the most unfavorable prognosis, namely IBC and NBC with multiple positive axillary nodes. EGFR gene was neither amplified nor rearranged. A restriction fragment length polymorphism (RFLP) for HindIII endonuclease was observed. EGFR transcripts were detected in 46% of tumors and observed more frequently in IBC than in NBC (p less than 0.02). In NBC the presence of EGFR transcripts increased linearly with lymph-node involvement and was associated with estrogen-receptor-negative tumors (p = 0.01). Analysis of both genes from the same tumor samples indicated that genes are associated with cancer aggressiveness. Furthermore, in NBC these 2 genes were independently activated, in contrast to IBC in which activated genes were negatively correlated, suggesting that c-erbB-2 and EGFR genes play different roles in NBC and IBC.

Structure and expression of c-erbB-2 and EGF receptor genes in inflammatory and non-inflammatory breast cancer: prognostic significance.

We report the largest series of induction chemotherapy for inflammatory breast carcinoma (IBC). Results of two chemotherapy protocols with radiation therapy (RT) (170 patients) are compared with results with radiation alone (60 patients) in the treatment of this disease. From 1973 to 1975, 60 patients (control, group C) received RT (45 Gy and 20 to 30 Gy boost) and hormonal manipulation. From 1976 to 1980, 91 patients (group A) were treated with induction chemotherapy: Adriamycin (Adria Laboratories, Columbus, Ohio), vincristine, and methotrexate (AVM) and RT on a cyclical schedule; and maintenance chemotherapy: vincristine, cyclophosphamide, and 5-fluorouracil (5-FU) (VCF). From 1980 to 1982, 79 patients (group B) received induction chemotherapy, Adriamycin, vincristine, cyclophosphamide, methotrexate, and 5-FU (AVCMF) and RT on a cyclical schedule and VCF maintenance. Hormonal manipulation was performed in all groups. Disease-free survival at 4 years was 15% for group C, 32% for group A, and 54% for gro...

Primary chemotherapy in the treatment of inflammatory breast carcinoma: a study of 230 cases from the Institut Gustave-Roussy.

Fifteen patients with clinical primary inflammatory carcinoma of the breast were treated with initial chemoimmunotherapy between September 1974 and May 1977. The protocol was a combination of Adriamycin, vincristine, 5-fluorouracil, and methotrexate given by I.V. push, and melphalan per os. Thermographic cooling was taken as the criterion of operability. Initial chemotherapy was resumed after surgery up to a total of ten courses and followed by maintenance chemotherapy for a minimum of one year. Immunotherapy using I-BCG-F. Pasteur was routinely associated with the antimitotic agents. The median survival for our 15 patients has not been reached and exceeds 56 months. These results correspond to an obvious therapeutic benefit compared with recent attempts in which similar chemoimmunotherapy protocols were used; this benefit seems to be the consequence of the adaptation of the length of initial chemotherapy to the data given by plate-thermography.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819820415%2949%3A8%3C1537%3A%3AAID-CNCR2820490805%3E3.0.CO%3B2-E

Initial chemoimmunotherapy in inflammatory carcinoma of the breast.

La thermographie en plaque.

Sixteen patients with clinical primary inflammatory carcinoma of the breast were treated with initial immunochemotherapy from September 1974 to May 1977. This chemotherapy was an association of adriamycin, vincristine, fluorouracil, methotrexate, and melphalan. Thermographic cooling was taken as the criterion of operability. Chemotherapy was resumed after surgery up to a total of ten periods, and followed by a minimum one year chemotherapy. I-BCG-F Pasteur was used as immunotherapy and associated with the chemotherapy regimen. Five patients have died, four are alive with disease, and seven are free of disease at time of reporting. Median survival exceeds 90 months. Our data supports the conclusion that mastectomy combined with preoperative and postoperative immunochemotherapy may permit a better prognosis for inflammatory carcinoma of the breast: this benefit seems to be the consequence of adapting the length of initial chemotherapy to the data given by plate-thermography.

Inflammatory cancer of the breast. Assessment after 6 years of 16 patients treated by primary immunochemotherapy

The preliminary study is concerned with 25 cases that have been examined using thermography in planes to check the conditions of temperature of the testes in normal and pathological states. Normal testicular thermography is characterised by a symmetrical and constant thermographic picture, the temperature staying between 32.5 and 34.5 degrees. In the pathological states of oligoasthenospermia plate thermography shows up a particular thermic picture associated with a varicocoele whether this is clinical or subclinical. The picture is one of hyperthermia and lack of symmetry in the case of a unilateral lesion. In these cases tyeing off the spermatic vein shows a rapid return to a normal thermographic picture. These positive results have led to a more extensive and deep study which is at present in progress.

Amiel Jp

Papers

Initial chemoimmunotherapy in inflammatory carcinoma of the breast.

La thermographie en plaque.

Inflammatory cancer of the breast. Assessment after 6 years of 16 patients treated by primary immunochemotherapy

Thermography of the testicle. Preliminary study

Thermographie et diagnostic des petites tumeurs du sein.