Is surgery an effective treatment for late stage inflammatory breast cancer?

The authors aimed to determine the effectiveness of surgery for the treatment of breast cancer; specifically those within the later stages of inflammatory breast cancer.

Inflammatory breast cancer  is a rare form of breast cancer, accounting for only 2% of all breast cancers. It is termed 'inflammatory' as the breast appears red, swollen and 'inflamed'. Metastasis (the spread of the cancer to distant organs) is typically observed in 30% of all new inflammatory breast cancer cases.

Tumor resection is the surgical removal of tumor tissues from the breast and it is a form of breast cancer treatment. To date however, the effectiveness and prognosis (treatment outlook) of surgery on advanced inflammatory breast cancer has not been well studied.

The aim of this study was to determine the effectiveness of surgery in treating patients with stage IV inflammatory breast cancer.

A total of 172 patients were evaluated for this study, of whom 79 underwent surgery and 93 did not. All patients underwent chemotherapy. 39% of patients received hormone therapy, while 73% of those with HER2+ cancer (the presence of the HER2 protein on the cancer cells) received the HER2-targeted therapy, trastuzumab (Herceptin).

Patients who responded to chemotherapy achieved better outcomes, with 41% of those who responded still alive at 5 years compared to 13% of those who did not. 

Overall, surgery improved the prognosis of patients with inflammatory breast cancer. 47% of patients who received surgery were alive after 5 years compared to 10% of those who did not receive surgery. 

Receiving radiotherapy and surgery further improved patient prognosis. For these patients, the survival rate after 5 years was 50% compared to 25% for those who had surgery alone and 14% for those who had radiotherapy alone. 

55% of patients had metastatic cancer that was limited to a single site, which was associated with a better prognosis. 34% of patients with only 1 site of metastasis were alive after 5 years compared to 18% of those with more than 1 site. 

The authors concluded that for patients treated with chemotherapy, surgery followed by radiotherapy achieved the best survival outcomes in late stage inflammatory breast cancer.

Surgical treatment for metastatic inflammatory breast cancer has always been controversial.