Inflammatory Breast Cancer: When Initial Neoadjuvant Therapy Fails to Achieve Operability
In inflammatory breast cancer (IBC), achieving sufficient tumour response to permit surgery is a critical early milestone. When a first course of neoadjuvant therapy does not reach that threshold, a structured next-line protocol takes over.
Previous Line — Why Escalation Is Triggered
The prior approach — cytotoxic chemotherapy and/or preoperative radiation — did not achieve the key goal of rendering the breast tumour operable. This unmet target is the criterion that escalates management to the current protocol.
Current Protocol — Partial Overview
The next step centres on definitive surgery with axillary dissection, followed by radiation to the chest wall and regional nodes, with completion of systemic therapy guided by tumour receptor profile.
References
- Total mastectomy (skin-sparing and nipple-sparing mastectomy are contraindicated) + level I/II axillary dissection + RT to chest wall and comprehensive RNI with inclusion of any portion of the undissected axilla at risk ± delayed breast reconstruction
- Complete planned cytotoxic regimen course if not completed preoperatively plus endocrine treatment if ER-positive and/or PR-positive (sequential chemotherapy followed by endocrine therapy).
- Complete up to one year of HER2-targeted therapy if HER2-positive (category 1). May be administered concurrently with RT and with endocrine therapy if indicated.
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