Surgery for Inflammatory Breast Cancer: How and Why
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Part of the 2017 Metastatic Breast Cancer Forum, held by Dana-Farber Cancer Institute.
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Surgery for Inflammatory Breast Cancer: How and Why
- 1. Faina Nakhlis Division of Surgical Oncology Dana Farber Cancer Institute 1st Annual IBC Patient Forum May 13, 2017 Surgery for Inflammatory Breast Cancer (IBC): How and Why
- 2. Histologic Evaluation Dermal lymphatic invasionGrade 3 invasive ductal carcinoma Image-guided core needle biopsy +/- skin punch biopsy
- 3. Initial Evaluation Peau d’orange (dermal lymphatic invasion) Unresectable disease 1. Neoadjuvant systemic therapy for cytoreduction 2. Modified radical mastectomy 3. Chest wall and regional nodal radiotherapy* *Morris, Journal of Surgical Oncology 1983; Dawood et al. Annals of Oncology 2011
- 4. What is the Role of Surgery in IBC Survival in 28 patients with IBC (23 patients with stage III disease) with and without surgery, 1969-1980 Hagelberg, Jolly, Anderson, Am Journal of Surgery 1984
- 5. What is the Role of Surgery in IBC Recurrence and survival in 107 patients with IBC with and without surgery, 1958-1985 Fields et al, Cancer 1989 Multivariate Analysis
- 6. What is the Role of Surgery in IBC Response to chemotherapy, receipt of surgery and outcomes in 178 IBC patients 1974-1993, median follow-up 89 months (22-223 months) Fleming et al, Ann Surg Oncol 1989
- 7. What is a Modified Radical Mastectomy Mastectomy (total, simple) + Axillary lymph node dissection
- 8. Why Mastectomy The cancer is often present throughout the breast at the time of diagnosis
- 9. Why Axillary Lymph Node Dissection? Axillary lymph nodes are almost always involved at diagnosis and it may be unsafe to not to remove them
- 10. Drains Round Jackson-PrattRound Blake Flat Jackson-Pratt
- 11. Why Should Immediate Reconstruction Not Be Done in IBC? The amount of involved skin can go beyond what is clinically visible
- 12. Patterns of Breast Reconstruction in Patients Diagnosed with Inflammatory Breast Cancer: the Dana Farber Cancer Institute’s Inflammatory Breast Cancer Program Experience F. Nakhlis, M.M. Regan, Y.S. Chun, L.S. Dominici, J.R. Bellon, L. Warren, E.D. Yeh, H.A. Jacene, K. Hirko, A. Hazra, J Hirshfield- Bartek, T. A. King, B. Overmoyer SABCS 2015 Poster
- 13. Background • Immediate reconstruction is not advised in IBC patients due to lack of safety data for skin-sparing mastectomy • Data on breast reconstruction outcomes in IBC patients are scant • Our experience with breast reconstruction in IBC patients was reviewed
- 14. Methods • Retrospective analysis of IRB-approved DFCI IBC database • Patients included in the analysis • Stage III IBC • Sufficient response to preoperative chemotherapy to achieve resectability • No preoperative radiotherapy • No loco-regional progression or distant metastasis during preoperative chemotherapy
- 15. Results Stage III IBC patients* (1997-2014), n=167 Immediate reconstruction, n=12 Delayed reconstruction, n=18 No reconstruction, n=135 *In two patients breast reconstruction took place but no information about reconstruction details and follow-up is available
- 16. Immediate Reconstruction, n=12* Reconstructive Option Number of Patients Tissue expander 3 Single stage implant 3 DIEP flap 1 TRAM flap 4 Latissimus Dorsi flap 1 *Eleven out of 12 patients with immediate reconstruction underwent surgery outside of DFCI
- 17. Delayed Reconstruction, n=18 Reconstructive Option Number of Patients Tissue expander 1 TRAM flap 9 DIEP flap 5 Latissimus Dorsi and tissue expander 1 Latissimus Dorsi flap 2
- 18. Complications After Delayed Reconstruction Complication Delayed Reconstruction (N=18) Reoperation for flap donor site wound dehiscence 1 (6%) Reconstruction loss 1 (6%) Total Complications 2 (12%)
- 19. Future Direction • Exploration of the role of local therapy (surgery and radiation) in stage IV IBC •Axillary and extra-axillary lymphatic drainage in IBC and the potential for sentinel node mapping