In response to “outcomes of patients with inflammatory breast cancer treated by breast conserving surgery”: the argument against breast conservation and sentinel lymph node biopsy in IBC

Excerpt

In October 2016, Brzezinska et al. advocated for the use of breast conservation therapy (BCT) in select patients with inflammatory breast cancer (IBC) [1]. Thirty-five patients who were diagnosed with IBC from 1999 to 2013 and treated with BCT were reviewed from a prospectively collected database. All patients had a localized solid tumor component in the breast and were treated with trimodality therapy: neoadjuvant therapy, surgery, and adjuvant radiation. They were selected to undergo breast-conserving surgery at the discretion of the multidisciplinary treatment team if the erythema and characteristic peau d’orange resolved following neoadjuvant therapy. Surgical management consisted of segmental mastectomy with axillary staging in most of the cases. Management of the axilla included axillary lymph node dissection in 20 patients, sentinel lymph node dissection (SLND) in 14 patients (resulting in completion ALND in four patients), and axillary radiation alone in one patient. SLN identification rate was 100%. All the patients received adjuvant whole breast irradiation. Excellent results were demonstrated in loco-regional recurrence (LRR)-free survival (87.5%—5 year LRR-free survival) and actuarial survival (70.3%—5-year survival) over a considerably long follow-up (median 80 months). …