Radiation Therapy for Inflammatory Breast Cancer: One Size Fits All?
WENDY WOODWARD, M.D., PH.D., DEPUTY DIRECTOR, MORGAN WELCH IBC PROGRAM
One of the things that I value the most about practicing radiation oncology at MD Anderson is our extensive clinical history.
As a clinician, there are few things worse than not knowing the right thing to do in a difficult situation. At MD Anderson, we are often faced with unusual or rare problems that are almost always difficult situations.
This is because there are no large data sets or randomized trials on which to base treatment decisions for rare diseases.
There is no clear right answer. That is where decades of institutional experience in rare and unusual problems comes in, to guide us in selecting the best therapy possible based on the best data available.
Our institution has been tailoring radiation therapy for this disease longer than chemotherapy has been offered. Before chemotherapy existed, many patients were not candidates for surgery due to the extent of their disease, and radiation was the mainstay of therapy.
During this time we developed a more aggressive, twice-a-day radiation approach to establish control for these patients.
In the chemotherapy and surgery era we learned that even after surgery, patients with inflammatory breast cancer have high local recurrence rates with standard post-mastectomy radiation. We brought our more aggressive techniques to this setting with good outcomes.
As chemotherapy and surgery options have matured, radiation therapy for inflammatory breast cancer at MD Anderson has matured with them.
We now use our institutional experience to best select patients who benefit from aggressive radiation therapy and minimize toxicity for those with great response to chemotherapy and less risk of local recurrence.
Our history has clearly shown that this disease is more locally aggressive than non-inflammatory breast cancer. Abounding clinical evidence demonstrates that preventing local recurrence improves overall survival in breast cancer.
Based on experience going back longer than any current member of our team, we strongly advocate for individualized aggressive radiation treatment approaches for inflammatory breast cancer patients.
It can be accomplished in many ways, but one thing is for sure. When it comes to radiation for inflammatory breast cancer, one size does not fit all.